Pediheart: Pediatric Cardiology Today: Recent Episodes
Robert Pass
This week’s replay episode reviews the notion of the underrepresented in medicine physician and the decision to pursue pediatric cardiology. How would improved representation amongst the congenital heart work force result in better outcomes for patients? How does a diverse workforce foster improved communication with patients? What are some practical steps that can be employed to improve representation in the field? We speak with Dr. Ogochuckwu M Ezeoke Cox, MD of U. Mass about recent essay on this vital topic.
https://doi.org/10.1007/s00246-023-03144-7
This week we review a recent book entitled Reimagining a Child’s Heart: The Lone Pines of Congenital Cardiology which was recently published by Springer and which was authored by Dr. Thomas J. Kulik and Dr. Macdonald Dick. Drs. Kulik and Dick recount the innumerable steps in discovery that led to what the authors view as one of the pinnacles of achievement in our field, namely the palliation of children with HLHS and single ventricle disease. Dr. Kulik tragically passed suddenly in 2021 but his friend and colleague Dr. Dick completed the book that Dr. Kulik had spent over a decade toiling over. This week we sit down with Dr. Dick and also, briefly, Dr. Roberta Williams and Dr. Kulik's wife Ms. Linda Kulik to discuss the book, Dr. Kulik's legacy, mentorship and more. Dr. Dick also shares with us what he believes are the keys to a successful retirement. This is a rare opportunity to listen to some of the truest pioneers of our field, 'Lone Pines" themselves share their insights and warm stories.
For those interested, this is one of many sites to obtain the book:
https://www.amazon.com/dp/3031886070?lv=shuf&channelId=500&plpRedirect=mhFallback
Also mentioned in this episode are 2 prior episodes including our conversation with Dr. Michael Freed and our conversation with Ms. Patricia Meisol and links are below:
https://podcasts.apple.com/us/podcast/pediheart-podcast-203-a-conversation-with-dr-michael-freed/id1341472214?i=1000556610155
https://podcasts.apple.com/us/podcast/pediheart-podcast-320-the-extraordinary-life/id1341472214?i=1000677938143
This week we discuss a recent report from the team at SickKids in Toronto on minimally invasive cardiac surgery. What sorts of operations are most common for this approach? Why are length of ICU and length of hospitalization periods lower in this surgical cohort than more traditional midline sternotomy approaches? How does one train a surgeon to perform these operations if the surgical exposure is so small, allowing only the priimary surgeon to see the majority of the surgery? What are the limits of this sort of surgical approach? These are amongst the questions posed to the first author of this work, Associate Professor of Surgery at University of Toronto, Dr. Christoph Haller.
* DOI: 10.1016/j.jtcvs.2025.12.009
This week we review a recent report using data from the IMPACT registry assessing the rates of major adverse events during cath of the pediatric cardiomyopathy patient. How commonly are complications encountered and who is at greatest risk? How much additional risk is incurred by performance of an endomyocardial biopsy at the time of catheterization? Pediatric critical care expert, Dr. Alejandro Martinez Herrada of Nicklaus Children's Hospital provides his insights this week.
doi: 10.1161/JAHA.125.047780.
This week we delve again into the world of adult congenital heart disease and specifically the realm of biomarkers when we review a recent report of the proteomics of the adult Fontan patient. What is proteomics and how can this inform our understanding of the pathophysiology and adaptive pathways of the Fontan circulation? Are there meaningful differences in the patterns of protein expression between the adult Fontan patient and control 2 ventricle subjects? What might account for differences and how can we understand these differences to explain outcomes in the Fontan adult patient? We speak with the first and senior authors of this week's work, Professor Alexander Opotowsky of the University of Cincinnati and Mr. Ismael Assi who is a Sarnoff Fellow and soon to be 4th year medical student at the University of Cincinnati.
* DOI: 10.1016/j.jacadv.2026.102810
This week we speak with a true pioneer in pediatric cardiology, Professor Rica Arnon of Mount Sinai in NYC. Dr. Arnon's career has spanned from the mid 1970's right up to the present time where she is still working as a cardiology consultant and educator at Mount Sinai in Pediatrics after more than 50 years. In this episode we learn the travails of a pioneering women in medicine/cardiology as Dr. Arnon shares with us the challenges and triumphs of a career that balanced outstanding clinical excellence with a rich family life. Why did she travel from Israel to the US to train? How did she choose to become a pediatric cardiologist and who were her mentors? What makes a good teacher of cardiology for young learners? What advice can this master of cardiology provide regarding 'balance' in a clinically active life when one is also devoted to their family? What is better in our field today and what does Dr. Arnon believe may have been lost along the way? Dr. Arnon tells it to us 'straight' in a delightful conversation with a master clinician and teacher.
A conversation with Dr. Michael Freed:
https://podcasts.apple.com/us/podcast/pediheart-podcast-replay-of-203-a-conversation/id1341472214?i=1000681074493
A conversation with Dr. Welton Gersony:
https://podcasts.apple.com/us/podcast/pediheart-podcast-247-a-conversation-with-living/id1341472214?i=1000607813461
This week we review a recent meta-analysis of studies assessing efficacy of adenosine in children to terminate SVT. Does the PALS recommendation of 100 mcg/kg as a starting dose for SVT management make scientific sense given what we know about the efficacy rates of this dose? Why might inadequate doses be potentially dangerous for children with acute SVT? Is there adequate data to consider changes to the recommended starting dose in this situation? Dose adenosine work well for all forms of tachycardia involving the AV node? Pediatric emergency physician and family medicine physician, Dr. Lais dos Santos of Mossoro', Brazil shares the results of a large scale meta-analysis that she performed and offers some answers to these and other questions.
- DOI: 10.1007/s00246-026-04281-5
This week we review a recent report of a novel form of CPVT (catecholaminergic polymorphic ventricular tachycardia) with associated neurodevelopmental delays. What is the genetic basis for these patients? What is different about the arrhyhthmias seen and how they are triggered in this variant? Should all patients with CPVT be screened for neurodevelopmental delays? Should those with neurodevelopmental delays and RYR2 variants be screened for CPVT? Associate Professor of Peditrics at Baylor College of Medicine/Texas Children's Hospital, Dr. Christina Miyake, shares her deep insights this week.
doi: 10.1161/CIRCEP.124.013437
This week we go back 2.5 years and delve into the world of cardiovascular surgery when we review a review of STS data on the pulmonary artery band (PAB). The STS assigns a STAT category of 4 to this operation, denoting higher risk for mortality. Is this warranted? Are all PAB candidates equal? What features are associated with higher or lower mortality rates in patients undergoing banding? Should the data in this work drive innovation to avoid the PAB in some settings? These are amongst the questions posed to the senior author of this week's work, cardiovascular surgeon Dr. Tara Karamlou who is Professor of Surgery at the Cleveland Clinic in Cleveland, Ohio.
DOI: 10.1016/j.athoracsur.2023.09.020
This week we speak with 2 pioneers in the field of pediatric cardiac critical care, Dr. Anthony Rossi and Dr. Gil Wernovsky. Both were present at the very start of the field of cardiac critical care for children. What was it like in an era before transesophageal echocardiography or even postoperative echo? Why was the advent of the bidirectional cavo-pulmonary anastomosis such a game changer in the care of children with heart disease? What do Drs. Rossi and Wernovsky think were the most important improvements to care for children with heart disease in their 35+ year careers? What about care today troubles these intensive care gurus? This is a rare opportunity to speak with two who have seen and done it all in cardiac critical care for children.
For those interested to hear Dr. Rossi speak about goal directed therapy, take a listen to episode 21 and episode 200 of this podcast!
This week we review a recent report from the team at Amrita Institute in Cocchin, India about their use of extended reality and virtual reality as well as heart model printing to aid in planning for complex intracardiac baffles for the treatment of complex congenital heart defects. What was the process used to provide actionable advice in the operating room during surgery? How has the team in southern India created a workflow that can accurately predict this complex anatomy and the patches needed to successfully septate complex hearts? We speak with the director of the 3D imaging group at Amrita, Professor Mahesh Kappanayil about this remarkable achievement of imaging in collaboration with surgery.
- DOI: 10.1016/j.jtcvs.2026.03.616
This week we review a landmark paper from the NEJM by the SCOUT-HCM study group assessing the impact of mavacamten on HCM in the adolescent patient. How does this agent work and what impact did it have on the LVOT gradients in obstructed HCM teens? Does this agent affect other biomarkers associated with more obstruction in this setting? Who is a good potential candidate for the use of this agent? Why must the EF be carefully monitored while using this agent? Dr. Joseph Rossano, Professor of Pediatrics at The University of Pennsylvania and the chief of pediatric cardiology at The Children's Hospital of Philadelphia joins the podcast to discuss this groundbreaking work.
doi: 10.1056/NEJMoa2601103
This week we feature a collaboration episode between the Pediheart Podcast and the PedsCrit Podcast in which pediatric critical care experts Drs. Alice Shanklin of Northwell Medical Center and Dr. Zac Hodges of UT Southwestern discuss the evaluation and management of heart block in children. What should the clinician be thinking when encountering a previously healthy child with heart block? When is pacing indicated and how should it be performed? Who is a candidate for transvenous or transcutaneous pacing, who is not and why? Drs. Pass, Shanklin and Hodges review many aspects of this in an episode from the PedsCrit Podcast.
https://www.pedscrit.com/
This week we review a recent work from the CT group at NY Presbyterian assessing the impact of phenylephrine during pediatric congenital CT scans to lower heart rate. Why is a lower heart rate better for CCT's? Should this agent be routinely employed for this indication during CT scans in children? Dr. Yosef Cohen, pediatrics resident at the Children's Hospital at Montefiore shares his insights from a recent work he co-authored.
doi: 10.1093/ehjimp/qyag023. eCollection 2025 Aug.
In this replay episode from 2 years ago, we delve into the world of adult congenital heart disease to review the topic of liver disease in the Fontan patient and specifically, hepatocellular carcinoma (HCC). What is the prevalence of this disease in the Fontan single ventricle adult patient? How effective are scores like the MELD-XI or Fibrosis-4 Index at identification of HCC in the Fontan patient? How should the Fontan adult patient be surveilled for this form of cancer? What evidence is there that earlier identification of HCC is associated with better outcomes? What may prove to be the most important factor in protection of the liver in the Fontan patient? Dr. Yuli Kim, Director of the ACHD program at The University of Pennsylvania shares her deep insights this week into this important topic.
* DOI: 10.1093/eurheartj/ehad788
This week we review a recent Australian prospective assessment of aspirin resistance in children undergoing heart surgery. How common is this seen in this patient group and what are the reasons? What is the best test to perform to assess this and what tests may not be worthwile? Who deserves 'routine' testing for this possible problem? Cardiovascular surgeon Dr. Supreet Marathe of Queensland Children's Hospital in Brisbane, Australia shares the results of this recent publication.
- DOI: 10.1016/j.jtcvs.2025.09.013
This week we speak with Assistant Professor of Pediatrics at Harvard Medical School, Dr. Audrey Dionne about a recent work she co-authored on sinus node dysfunction following congenital heart surgery. How common was this encountered and how often were either temporary or permanent pacing needed? Are there certain surgeries that are more associated with the need for pacing after surgery? Why is this so common following heart surgery? Dr. Dionne shares her deep knowledge this week on this surprisingly common problem.
* DOI: 10.1016/j.hrthm.2026.01.049
In this compelling lecture by Dr. David Winlaw of Northwestern University, we hear his thoughts on the state of the CICU/Surgeon relationship and he offers his thoughts on how to improve care for children with congenital heart disease undergoing surgery. Why does he believe that the more old fashioned approach of having cardiac programs run by academic departments is no longer optimal? What do critical care doctors not understand about surgery and vice versa? Are we asking too much of our CICU practitioners? How can the 'shift work' mentality be abolished and how can we avoid burnout for our critical care front line staff while also improving outcomes for patients? How can we bring joy back into the care of children with critical heart disease? Dr. Winlaw shares his insights from a long career in multiple centers worldwide in the Thomas J. Spray Lecture at the Cardiology 2026 CHOP conference from late February, 2026 in Arizona.
This week we sit down and speak with noted non-invasive imaging expert Dr. Kelly Han of U. Utah about a recent work she co-authored on recommendations for the development of a congenital heart CCT program. What are the absolute essentials when considering offering these services in a center? How do different scanners differ from one another and how important is it to have single vs. dual source CT? Can good work be performed on 'older' machines? Who are the most important team members for a congenital CT team? Dr. Han shares her thoughts as well as the ideas of many of the thought leaders who co-authored this important statement paper.
- DOI: 10.1016/j.jcct.2025.01.003
This week we listen in to a recent presentation by congenital heart nursing pioneer Ms. Gwen Fosse BSN MSA RN FAHA. Ms. Fosse is a pediatric cardiovascular nursing specialist at Mott Children's Hospital at U. Michigan and has literally done and seen it all over the past 50 years in congenital heart nursing. In this presentation from the CHOP Cardiology 2026 meeting Ms. Fosse shares with us her impressions from a career that spans multiple decades and advances in the field. This presentation was the 26th Annual Thomas Garrett Rauch Memorial Lecture in Nursing at this esteemed conference.
This week we speak with Professor James Cnota of Cincinnati Children's Hospital about a recent report he co-authored from the SVR trial regarding the impact of tricuspid regurgitation (TR) on outcomes in hypoplastic left heart syndrome (HLHS). How common is TR seen in the HLHS patient and how does this change over time after surgical palliations? Is there an optimal time to intervene on the tricuspid valve in this patient group? What does the future hold for tricuspid surgical interventions? Dr. Cnota has the answers this week.
doi: 10.1007/s00246-025-04122-x
This week we listen in to a wonderful presentation that was delivered at the CHOP 2026 annual conference which was held in Phoenix, AZ. In this week's lecture we hear Dr. Gail Pearson of the NHLBI and NIH deliver her thoughts about the future of congenital heart research. Where does this master of research believe the next discoveries are going to arise from? What are the lessons we have learned from the PHN research endeavors over the past 25 years? Dr. Pearson offers her thoughts in this wonderful presentation which was the 24th Annual William J. Rashking Memorial Lecture at this conference. This presentation was delivered on 2.28.26.
This week we speak with Dr. John Brown who is the Harris B. Schumacker Professor Emeritus of Surgery at the University of Indiana. A congenital heart surgeon for over 45 years, Dr. Brown has performed more than 15,000 pediatric heart operations at Riley Hospital for Children and another 5000 heart operations in adults at IU and Methodist Hospitals. He performed the first pediatric heart transplant in Indiana and developed the first clinical use of the bovine jugular vein and valve for a pulmonary valve replacment in children. He also performed the only known twin to twin newborn heart transplant in the world. He has done and seen it all and has a unique perspective. How did he achieve so much and still have a succesful 56 year marriage to his wife Carol Ann? What is Dr. Brown most proud of in a career that is as prolific as his? What advice would he have have for the next generation? Prepare to be inspired by this master surgeon and friend and colleague of many in our field.
This week we review a fascinating very long-term surgical follow-up study from the team at Royal Children's Hospital in Melbourne reviewing over 30 year follow-up following the arterial switch operation for the treatment of transposition of the great vessels. What percentage of patients need reintervention by 30 years post neonatal repair? What anatomical sub-types are more likely to be associated with a need for reintervention and why? When intervention is required for neo-aortic or aortic root problems, can these usually be repaired or do they require replacement? Professor Igor Konstantinov from Melbourne shares his deep insights into this complex patient group.
* DOI: 10.1016/j.jtcvs.2025.09.008
Why are compassion, kindness and humility critical to the care of patients in 2026? How can practitioners be taught these approaches and how does this 'triple gift' not only improve patient care but also professional interactions? Can this be taught? If so, what are the best ways? Professor Colin McMahon of Children's Health Ireland at Crumlin shares his deep insights into this important and oft-neglected aspect of being a caregiver.
- DOI: 10.1007/s00246-026-04161-y
Following today's interview we also briefly speak with Professor Jack Rychik of Children's Hospital of Philadelphia about the upcoming CHOP 2026 meeting entitled "Cardiology 2026 - Together!". For those interested in possibly attending this meeting which begins on 2.28.26, take a look at the website below for more information:
https://www.chop.edu/events/cardiology-2026
This week we replay an episode from nearly 2 years ago about an editorial commentary from multiple congenital heart surgical leaders in the US. The topic of their expert opinion piece is the concept of public reporting of results and their 'amplification' through organizations such as US News and World Report, to name one. How has the use of the database from STS been sometimes misinterpreted through public reporting or ranking systems? What was the initial intent of the STS database and how does the present usage of these data differ from the initial intent? Do STS risk adjustment models capture all aspects of risk for patients undergoing surgery and how do deficiencies in this result in unfair 'rankings' of programs? Can we 'take control' of our data and interpret it more clearly and accurately for the public and reduce misusage or misinterpretation of the data? How can public reporting result in improved outcomes? How can 'gaming' of the system be reduced? Dr. Emile Bacha, Professor of Surgery at Columbia University shares his deep insights into a complex and challenging topic.
- DOI: 10.1016/j.jtcvs.2023.03.022
This week we review a recent work on fetal atrial septal interventions in the patient with hypoplastic left ventricle or double outlet right ventricle with mitral valve atresia/dysplasia and a restrictive or intact atrial septum. How often was this procedure technically feasible and successful? What are the criteria to be considered for such an intervention? Why does use of a laser improve the crossing of the atrial septum in this procedure? Should prenatal intervention be used instead of postnatal intervention in this setting? Associate Professor of Pediatrics at Baylor College of Medicine, Dr. Betul Yilmaz shares her insights into this fascinating topic.
https://doi.org/10.1161/CIRCINTERVENTIONS.125.015209
This week we replay an important episode from 2 years ago in which we delved into the world of antibiotic prophylaxis for dental procedures. What are the data to support its use in the congenital heart patient? Why has this been such a difficult topic to study? What do we now know about this topic and what still remains unanswered? Given the low prevalence but dire consequences of this disease, how can investigators consider studying this topic in the future? Is there adequate equipoise to proceed with a randomized controlled trial? We speak with Advanced Imaging Fellow at Boston Children's Hospital, Dr. Francesca Sperotto of Harvard University about her recent multicenter meta-analysis of 30 studies including over one million cases of endocarditis. * DOI: 10.1001/jamacardio.2024.0873
This week we review a follow-up work from the team at USC and Children's LA led by Dr. Yaniv Bar-Cohen on a novel micropacemaker. How has the device changed and improved over the past 3-5 years since his last visit to Pediheart? What are some of the difficulties of designing a device that is both stable on the epicardium but not inclined to develop inflammation? Why did the team move from a screw in eletrode model to a different design? What applications could this device have both for infants but also adults? Dr. Bar-Cohen shares his deep knowledge of both electrophysiology and device design this week.
- DOI: 10.1016/j.hrthm.2025.01.036
For those interested in stepping back in time to hear Dr. Bar-Cohen's first description of an earlier version of this novel pacemaker, here is the link from 2018:
https://podcasts.apple.com/us/podcast/pediheart-podcast-26-novel-means-of-epicardial/id1341472214?i=1000498801107
This week we review a recent large scale PHIS database study on pericardial effusion following congenital heart surgery. Which operations other than ASD are most highly associated with the development of an effusion? What might be some approaches both surgically and medically to reduce the chances of these developing or requiring intervention? What are the implications of a pericardial effusion after surgery? How many require readmission for this complication? Dr. Mario O'Connor, who is a congenital heart surgical research fellow at UT Austin, shares his insights into his recent publication.
- DOI: 10.1177/21501351251322876
This week we review a recent report on LV strain following the Ross operation. Can this sort of functional analysis help predict remodeling after aortic valve replacement? How can the type of Ross potentially affect heart function after the operation? Why might some parameters of LV strain improve but others not following surgery? Can preoperative strain measurements predict perioperative course? How does the addition of a Konno to a Ross change the outcomes of function? We speak with Chief of Cardiovascular Surgery at Primary Children's Hospital in Utah, Dr. S. Adil Husain and 3rd year integrated cardiac surgical resident Michal Schaffer of the University of Utah about these and other topics related to LV function following the Ross operation in children.
· DOI: 10.1007/s00246-025-04124-9
This week we end 2025 with a Pediheart tradition - an episode on personal finance for medical professionals with noted authority on index investing and personal finance, Mr. Paul Merriman. Paul is a retired investment advisor who now has a popular podcast "Sound Investing" and website in which he offers advice on investing for 'do it yourself' investors. In this week's episode, the 5th of his visits to Pediheart**, Mr. Merriman discusses 'factor investing' via index-like ETF's and funds. He also reviews who he believes might benefit from a financial advisor, what sort of advisor most should seek out and why he believes that many do not need one if they can 'stay the course'. Resources mentioned in today's podcast are below. Wishing all a happy and healthy new year in 2026.
Paul's website:
https://www.paulmerriman.com/#gsc.tab=0
'Best In Class' ETF's:
https://www.paulmerriman.com/Best-in-Class-ETF-Recommendations2025#gsc.tab=0
Sound Investing 'Quilt Charts':
https://irp.cdn-website.com/6b78c197/files/uploaded/(K)_Quilt_Charts_(1928-2024)_-_2024_Returns_(1).pdf
DFA 'Turn Out The Noise':
https://www.dimensional.com/film
As a reminder, all of the information provided in this week's episode should be considered entertainment and all financial decisions should be vetted with professionals or knowledgeable and trusted friends/family.
This week we go back in time 2 years to review a recent paper from 2023 about outcomes of cardiac transplantation in the adult congenital heart patient (ACHD). Little has been written on this topic until this very robust and large scale report. How do single ventricle ACHD patients fair at transplant and how do they compare to non-ACHD heart transplant recipients? Why might 1 and 3 year outcomes not be a 'fair' method of assessing outcomes in this very high risk patient group? How do HLHS patient outcomes compare with other single ventricles? Are there better ways to measure risk in this patient group and how might the data in this work inform risk stratification and management of failing Fontan patients in whom transplantation is being considered? These are amongst the questions posed this week to the week's expert, Dr Daphne Hsu who is Professor of Pediatrics at the Albert Einstein College of Medicine at The Children's Hospital at Montefiore.
https://doi.org/10.1016/j.jacc.2023.06.037
For those interested in learning more about Dr. Hsu, take a listen to episode #166 from June, 2021:
https://www.spreaker.com/episode/pediheart-podcast-166-a-conversation-with-professor-daphne-hsu--45144274
This week we speak with noted congenital cardiologist Professor Krishna Kumar of the Amrita Institute in Cochin, India and discuss his recent work on inequities in congenital heart care in the world. Over 90% of patients with CHD do not have access to care in the globe today. What is the path forward to improve this sobering statistic? How can a World Health Assembly resolution practically help improve care in LMIC countries worldwide? Dr. Kumar shares his deep insights.
This week we also briefly note the passing of the wonderful and caring pediatric cardiologist Dr. Sangeetha Viswanathan of Chennai, India who tragically died suddenly this week while attending the World Congress events in Hong Kong. Dr. Kumar's words regarding his friend, former fellow and colleague are read in remembrance of this wonderful and giving cardiologist whose loss will be deeply felt by her patients, family and friends.
- DOI: 10.1016/j.jacc.2025.07.070
ECMO is the topic of this week’s episode of Pediheart. We speak with Assistant Professor of Pediatrics and cardiac critical care specialist at Northwell Health, Dr. Ivana Capin about a recent ELSO database study she conducted to assess outcomes in single ventricle patients who were treated with ECMO prior to single ventricle palliation. What factors were associated with worse overall outcomes? Can this therapy be used to stabilize the HLHS patient with an intact atrial septum? Why have outcomes for this high risk patient group not appreciably improved in the recent decade? How can these data improve prognostic clarity when speaking with families in this difficult situation.
Also joining us briefly is Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai, Dr. Scott Aydin to discuss his co-author and mentor, Dr. George Ofori-Amanfo as we approach the 4th anniversary of his untimely and tragic passing.
- DOI: 10.1017/S1047951125001386
This week we go back in time to 2020 to delve into the topic of fellow wellness and review a work from the Boston Children's group on fellow fears and stressors when beginning their training. Are there patterns amongst the fellow concerns that can be identified and used to inform interventions to help allay these fears and reduce the stress? We speak with Dr. David Brown, Associate Professor of Pediatrics, Harvard Medical School and also Dr. Tony Pastor who was then the ACHD Fellow at Boston Children's Hospital/Brigham and Women's Hospital about their thoughts on fellow fears and stressors as well as fellow (and doctor) wellness.
doi: 10.1007/s00246-019-02276-z.
This week we review the topic of mitral annular disjunction ("MAD") and the possible association with ventricular arrhythmia or sudden death in the connective tissue disease patient. Is there a 'cut off' distance above which patients deserve more significant arrhythmia surveillance? What is the best way to measure the MAD distance? Can patients with low MAD distances have lower degrees or even no arrhythmic surveillance? How often should this distance be measured on CMR and can an echo measurement provide similar data? Dr. Daniel Castellanos, the first author of this work and Assistant Professor of Pediatrics at Harvard Medical School shares his deep insights this week.
- DOI: 10.1016/j.jocmr.2025.101954
This week we review a recent retrospective review from Phoenix Children’s Hospital about coronary artery fistulae. How common are they and who needed intervention? How should the cardiologist think about the small fistula? Should they all be ‘followed’ or can they be discharged from cardiology follow-up? How small is ‘small enough’? We speak with Dr. Marie Chevenon who is a fetal cardiologist at Phoenix Children’s Hospital about her recent study on the Phoenix experience with coronary artery fistulae.
https://doi.org/10.1007/s00246-024-03600-y
This week we speak with Ohio State ACHD fellow Andrew Freddo MD, PhD about a recent large single center study he conducted assessing the cardiovascular drugs that adult Fontan patients are taking and whether they might offer us insights into general well-being. Are there agents that are associated with worse outcomes? If so, is this a situation of the agent causing harm or is it a possible marker of illness? Are there agents associated with improved outcomes? These are amongst the questions reviewed with Dr. Freddo this week.
- DOI: 10.1016/j.jacadv.2025.102070
This week we review the results of the new pivotal trial of the 'Minima' stent by Renata Medical. What is special about this new device that makes it particularly desirable for use in small children? How strong is cobalt chromium and what evidence exists that it can be expanded repeatedly over 1-2 decades? Can this technology supplant surgery for certain diseases such as native coarctation? What are the limitations of this device? We speak with the first author of the pivotal trial, Dr. Patrick Sullivan of CHLA who is Associate Professor of Pediatrics at Keck Medicine at USC.
- DOI: 10.1161/CIRCINTERVENTIONS.125.015618
This week we review a recent survey study assessing the beliefs of fetal cardiologists and how these may influence the content and conduct of their counseling. Do most fetal cardiologists review all options including intervention, comfort care and pregnancy termination? Should there be a mandate that all do? Is it realistic or appropriate to ask a fetal cardiologist to suggest an option when they do not believe it to be a reasonable or correct choice? We speak with two of the authors of this work and they are Dr. Joanne Chiu of Harvard University and Dr. Caitlin Haxel of The University of Vermont.
- DOI: 10.1002/pd.6706
This week we review an episode from 3 years back and delve into the world of adult congenital heart disease when we review a recent work from the ACHD team at UCSF that assesses the impact of BMI on clinical outcomes in the single ventricle adult Fontan patient. What is the cause of elevation in BMI in some Fontan patients? Is obesity the only explanation? Is BMI a modifiable risk factor for our Fontan patients and should exercise be 'prescribed' for these patients? If so prescribed, what type of exercise is best for the Fontan patient? This week's work's senior author, Dr. Anushree Agarwal, Assistant Professor of Medicine at UCSF, shares her insights into this important topic.
DOI: 10.1161/JAHA.122.026732
Also mentioned in today's episode is episode #222 with Dr. Dan Halpern of NYU medical center (https://www.stitcher.com/show/pediheartpediatric-cardiology-today/episode/pediheart-podcast-222-impact-of-cardiac-rehab-on-exercise-tolerance-in-the-achd-patient-206781483)
This week we review a recent work from the "Women In Pediatric Cardiology" group which is a 4 year old initiative to help lift up women pediatric cardiologists through the fostering of connections and also via mentorship programs. Why did this program develop and what are the most pressing issues affecting female pediatric cardiologists? What are the best solutions to help address gender inequities in our field? We speak with two co-authors of this week's work, Drs. Sarah Ford of Brown University and Kristin Laraja of University of Massachussetts. For those interested in participating in their work, feel free to email Pediheart@gmail.com and your information will be passed along to the authors.
- DOI: 10.1007/s00246-024-03576-9
This week we review a recent multicenter, randomized trial pitting 2 different immunosuppressive therapeutic approaches against each other. How did a novel approach of everolimus + low dose tacrolimus compare to more standard MMF + standard, higher dose tacrolimus in avoidance of major adverse transplant events or complications? How did this first ever prospective trial in the pediatric heart transplantation world start and how difficult was it to perform in the absence of corporate or NIH support? Why can these data help inform FDA labelling for this novel approach and why is this important? Dr. Kevin Daly of Boston Children's Hospital shares his deep insights into this work this week!
- DOI: 10.1001/jama.2025.14338
This week we review a recent report of the use of phenoxybenzamine for the reduction of SVR in children undergoing congenital heart surgery in India. How does this agent work and what might be the advantage versus other agents like nitroprusside or milrinone which are more commonly used? How does the cost of this agent (or phentolamine) compare with newer agents? We speak with Dr. Rohit Loomba of Lurie Children's Hospital. For those interested, in addition to working as a critical care cardiologist, Dr. Loomba is also a noted cardiac morphologist and his wonderful videos can be seen at the following web address:
https://www.youtube.com/@Talking_Hearts
Today's paper:
DOI: 10.4103/jpbs.jpbs_868_25
This week we replay an episode from 2 years ago on postoperative ectopic atrial tachycardia (EAT) following congenital heart surgery in children. Are there risk factors for this arrhythmia and are any modifiable? What is the 'go to' therapy used by the electrophysiologists at Children's LA for the acute and chronic treatment of this arrhythmia in the postoperative period? Is the presence of EAT in a postoperative congenital heart patient a marker for a worse outcome? These are amongst the questions posed to Children's of Los Angeles pediatric electrophysiologist, Dr. Jonathan Uniat.
· DOI: 10.1007/s00246-022-03068-8
This week we review a recent report from the Boston Children's team on their 39 year experience managing and caring for children with myocardial infarction following Kawasaki disease (KD). What were the clinical features of KD patients that were most associated with this rare complication? What signs or symptoms should be concerning for the caregiver of patients with KD? What are the more common approaches to the management of MI in this fragile and young patient population? Dr. Sunil Ghelani of Boston Children's Hospital offers the answers this week.
- DOI: 10.1016/j.jpeds.2025.114638
This week we review a landmark paper that came out this month on the topic of ACHD. How common is neurocognitive dysfunction amongst the ACHD patient population? What factors are associated with worse or better such outcomes? What interventions should be considered to mitigate these issues? What is the relationship between mental illness and neurocognitive dysfunction? Dr. Scott Cohen of The Medical College of Wisconsin and Dr. Ali Zaidi of The Icahn School of Medicine at Mount Sinai share their insights into their recent multicenter study.
doi: 10.1016/j.jacc.2025.06.051
Also featured after the article is a brief description of the upcoming Mount Sinai ACHD Conference called: Kawasaki Disease Across The Ages: From Childhood Onset To Adult Outcomes - The 4th Mount SInai ACHD Symposium. We speak with Dr. Nadine Choueiter who is the Course Director of this conference about the goals and objectives of the conference. Dr. Zaidi is the course co-director. For those interested in signing up, please go to this webpage:
https://physicians.mountsinai.org/news/register-today-for-the-fourth-annual-mount-sinai-adult-congenital-heart-disease-symposium
This year is the 50th anniversary of the first transcatheter ASD closure in a human. To celebrate this achievement, this week we air a live interview from PICS 2025 in Chicago (conducted 8/26/25) with living interventional cardiology legend Dr. Terry King speaking about the events surrounding his landmark intervention as the first person to ever perform a transcatheter ASD closure with his partner, surgeon Dr. Noel Mills. In this one on one interview, Dr. King discusses how he came up with this idea with Dr. Mills and how he found a patient in which to proceed. He reviews what 'informed consent' was in 1975 and also how he and Dr. Mills accurately estimated ASD size in an era that preceded 2D echocardiography. Dr. King speaks about the role of family in his life and offers advice to the next generation. Finally, he shares with us what he is up to today and why he does not believe in retirement. Prepare to be excited and inspired by this wonderful figure in our field.
This week we review a recent work addressing the growing mismatch between the numbers of ACHD patients and the numbers of well trained ACHD providers. What are the most important factors influencing trainees' decisions regarding the pursuit of a career in ACHD? How can more young people be influenced to pursue this fascinating and growing field? We speak with Dr. Katia Bravo-Jaimes of The Mayo Clinic in Jacksonville, FLA about a recent survey study she conducted on the factors that influenced these important decisions. Dr. Bravo-Jaimes shares her thoughts on solutions to increase the ACHD workforce.
https://doi.org/10.1161/jaha.125.041276
In this week's replay episode from 3 years ago, we delve into the world of pediatric heart transplantation and the impact that race or insurance status may have on outcomes. What are the factors that explain worse outcomes for black children waiting for a heart transplant? How is the PHTS Racial Disparity Taskforce working to reduce inequities in this field? What role does insurance status have on these outcomes? We speak with noted heart failure and transplantation expert, Dr. Neha Bansal who is Associate Professor of Pediatrics at The Icahn School of Medicine at Mount Sinai about this recent PHTS multicenter study.
* DOI: 10.1016/j.healun.2022.12.002
This week we lost one of the true 'nice people' in pediatric cardiology - Dr. Richard J. Golinko who died at the age of 95. Dr. Golinko led the Mount Sinai Pediatric Cardiology Program for many years. He established many of the programs at Sinai that are now fundamental to the program and the care of children with congenital heart disease in the tri-state region. To honor Dr. Golinko's memory, we stretch back over 40 years to review a paper he co-wrote with Dr. Rubin Cooper on balloon angioplasty of aortic coarctation. We speak with Dr. Cooper, the work's first author about the work as well as his remembrances of the man, Dr. Golinko. Also joining us this week is Dr. Anthony Rossi of Nicklaus Children's Hospital and Dr. Rica Arnon of Mount Sinai to share their individual remembrances of this wonderful and warm leader.
doi: 10.1161/01.cir.70.5.903
Professor Ziyad Hijazi of SIdra Medical joins Pediheart this week to celebrate Pediheart's 350th milestone and discuss his life and times from his early days in Jordan to the absolute heights of interventional cardiology. How did he meet Dr. Kurt Amplatz and become involved in the development of Amplatzer devices? Who were some of his mentors and what does he think about being a mentor? How did he come up with the idea for the PICS interventional course and how has he managed to do this consistently for over 20 years? What does he believe is important when thinking about a work/life balance? This is a rare opportunity to learn from someone who has seen and done it all in every corner of the world in pediatric cardiology.
For those interested, this is the link to the PICS course in late August, 2025 in Chicago:
https://www.picsymposium.com/home.html
This week we go back in time to 2022 to re-enter the world of cardiogenetics and electrophysiology when we review the topic of catecholaminergic polymorphic ventricular tachycardia (CPVT). Is there a 'best' beta blocker for the treatment of this condition? Why is one better than others? How should one manage the patient who is intolerant of beta blockade but needs it for prevention of arrhythmia? What is the role of flecainide, sympathectomy or even ICD's for these patients? PhD candidate and physician Dr. Puck Peltenburg and CPVT world authority, Dr. Christian van der Werf (both of University of Amsterdam) share their deep insights this week. doi: 10.1161/CIRCULATIONAHA.121.056018. Epub 2021 Dec 7
This week we review a recent important longitudinal follow up study of patients who have undergone palliation for the treatment of HLHS at The Children's Hospital of Philadelphia over the past 35+ years. What are the 'transplant-free' survival numbers at 35 years follow up following newborn palliation? Are there differences between hybrid and traditional "Norwood/Stage I" palliation? What factors explain the group of HLHS patients who do are 'super-Fontan's'? What accounts for the marked variability in outcomes of these complex patients? Dr. J. William Gaynor shares his deep insights both from his large scale paper and long-term experience caring for patients with HLHS.
doi: 10.1016/j.jacc.2025.04.028
This week we review a recent surgical paper on the 'off-label' use of the Melody valve for replacement of the AV valve in small infants and children. How effective and safe was this procedure? What factors were associated with the need for reintervention and what sorts of reinterventions were most common? Why was catheter based reintervention rarely employed? What sort of anti-coagulation protocol seems best to protect these valves? Assistant Professor of Pediatrics at the University of Nebraska, Dr. Samantha Gilg shares the insights from her work this week.
- DOI: 10.1007/s00246-024-03538-1
This week Dr. Nadine Choueiter of Mount Sinai hosts a special episode of Pediheart: Pediatric Cardiology Today in which we speak with emeritus Professor of Pediatrics at the University of Toronto, Dr. Brian McCrindle about his career and life. How did he develop a love of pediatric cardiology? Who were some of his early mentors? How did he develop the international Kawasaki Disease Registry and how has he cultivated it despite minimal funding? How did he develop an interest in preventive cardiology? How can a young person make their clinical work also their academic work? Dr. McCrindle also shares some insights into navigating a successful life as well as retirement. This is a rare opportunity to be inspired by one of the great pediatric cardovascular researchers of the past 3 decades.
This week we speak with congenital heart surgeon T. Konrad Rajab of Arkansas Children's Hospital about a recent report he co-authored on piglet experiments on partial heart transplantation. How did transplanted heart valves grow in comparison to standard homografts and how did the valvular function differ with time? Is there a minimum dose of immunosuppresion that can protect these valves and can this dose be lower than full heart transplantation immunosuppresion therapy? Is partial heart transplantation considered a potential life-long approach to valve replacement or mostly something used to allow for growth of valves during childhood? What do we know about the world's limited experience in humans of this approach? Dr. Rajab shares the answers this week in an exciting 'sci-fi' episode. The future is now.
https://doi.org/10.1016/j.jacbts.2024.10.015
This week we speak with Professor Vladimiro Vida of U. Padua about a recent ECHSA large scale study assessing surgical outcomes of newborn cardiac surgery in Europe. What trends have become apparent in the past 10 years and why are outcomes generally better overall in this complex patient group? Why have outcomes for single ventricle surgery not improved as much as other newborn surgeries? Is there a relationship between center volume and outcomes? What interventions might result in improvements in outcomes of Norwood palliation? Dr. Vida provides his insights this week.
https://doi.org/10.1016/j.athoracsur.2024.07.023
This week we speak with Assistant Professor of Pediatrics at Harvard Medical School, Dr. Audrey Dionne about a recent work she co-authored on the topic of outcomes of ablation in the early postoperative period following congenital heart surgery. Who is a candidate for this intervention and what were the outcomes? How commonly were serious complications encountered and how successful were these procedures? Dr. Dionne reviews these and other aspects of this novel review this week.
https://doi.org/10.1016/j.hrthm.2024.08.061
This week we venture back in time to 2023 to review the results of the update of the Single Ventricle Reconstruction trial, specifically SVR III. How are HLHS patients are faring post Norwood at age 12? What is the overall transplant-free survival rate in this group? Are there differences in survival seen at 12 years between BTTT shunt patients and RV-PA conduit shunt patients? How do they compare in exercise capabilities? What about rates of PLE or arrhythmias seen? Are there interventions that may improve outcomes going forward? These are amongst the questions reviewed this week with the first author, Dr. Caren Goldberg who is Professor of Pediatrics at the University of Michigan.
DOI: https://doi.org/10.1161/circulationaha.123.065192
This week we speak with Professor Robert Hamilton of the University of Toronto about a recent case-control study in which his team identified a novel auto-antibody targeting a fetal cardiac protein that proved to have excellent sensitivity and specificity for the identification of fetuses that would develop heart block in fetal life in the offspring of women with maternal connective tissue disorders. How did the team in Toronto choose these particular target proteins? How well did this test perform in predicting heart block in pregnancies where there had been a prior pregnancy affected by block? Does this test possibly mean that fewer fetuses of mothers with connective tissue will need surveillance? Dr. Hamilton shares the details of this fascinating study this week.
https://doi.org/10.1016/s2665-9913(25)00092-x
We also speak with Drs. David Ezon and Kenan Stern about the upcoming 16th Annual Mount Sinai Imaging Symposium - Conversations in Care: Cardiac Conundrums & 3D Echo Workshop which will be taking place at Mount Sinai on 5/31/25. Details are available at the following website:
https://mssm.cloud-cme.com/course/courseoverview?P=5&EID=46043
This week we move into the arena of preventive cardiology when we review a recent report from the team at Northwestern and Princeton on the impact of early childhood food insecurity on cardiovascular health of people in young adulthood. How does food insecurity in young childhood impact the cardiac health of adults? Why is most of the impact seen on BMI but not other measures of cardiovascular health. How can food programs that support improved food and nutrition security work to improve long term cardiovascular health of children and adults? Do the benefits of such programs outweight their costs? Dr. Nilay Shah of Northwestern University shares his deep insights into his work and these questions this week.
- DOI: 10.1001/jamacardio.2025.1062
This week we share the inspiring tale of Ms. Kayla Billington, a pediatric and neonatal critical care nurse who met a young boy with tetralogy of Fallot named Wavamuno Patrick in Uganda while working for an NGO hospital. Ms. Billington tells the story of meeting Patrick and struggling to save his life and how this simple relationship of love and caring led her to help many in Uganda with congenital heart disease. Ms. Billington speaks of partnering with Professor R. Krishna Kumar of the Amrita Institute and, in today's episode, both Ms. Billington and Dr. Kumar share the inspiring tale of how they have worked together to help save the lives of children from Uganda at Amrita. Prepare to be amazed by their tale. Ms. Billington's efforts highlight the critical need for congenital heart care in Uganda and many other nations in Africa.
For those interested, you can learn more about Patys Project and how you can help at:
https://patysproject.org
This week we take a trip back in time to reminisce about what it was like to be a fellow under famed pediatric cardiology pioneer Dr. Alexander S. Nadas. Who better to tell us about what life was like under this giant than 4 present-day giants who lived through it and got their start working for Professor Nadas. Joining the podcast in a live recording from the Boston Children's Cardiology 75th Anniversary Alumni Reunion on May 3rd are Dr. Roberta Williams, Dr. John Barry Keane, Dr. Patricia Rompf and Dr. Thomas Hougen. All have many stories to tell and they share their remembrances and insights in this special episode honoring the memory of the founder of the cardiac program at Boston Children's Hospital - Dr. Nadas.
This week we delve into the world of exercise physiology when we review a recent paper by Dr. Adam Powell of Cincinnati Children's Hospital on the relationship of hand grip strenth to other measures of cardiovascular and skeletal muscular health and fitness. How does hand grip strength correlate with CPET measures of exercise abilities in children? How might this inexpensive test help identify patients who might benefit from exercise therapy? Will hand grip strength one day be as ubiquitous as blood pressure in the evaluation of our CHD patients? Dr. Powell shares the answers this week.
https://doi.org/10.1016/j.jpedcp.2025.200144
This week we review a recent editorial commentary by Drs. Belinda Gray, Rachel Lampert and Michael Papadakis on the concept of the personalized emergency action plan for the patient with genetic heart disease who is 'returning to play' in vigorous sports. With newer data demonstrating that risk for SCA or SCD is perhaps not as high as was once thought in this setting of sport, can the development of a personalized emergency action plan further enhance safety beyond simple measures such as medical adherence? Who should be involved in drafting this emergency action plan and how does this feature in the concept of 'shared decision-making'?
DOI: 10.1161/CIRCULATIONAHA.124.072830
This week we review a study assessing the impact of bundle branch block (BBB) on exercise tolerance amongst the single ventricle Fontan patient cohort. Why would this be associated with worse outcomes for exercise? How should the cardiologist use this datum of BBB in a single ventricle patient to inform clinical decision making in this patient group? Why is cardiac resynchronization therapy so challenging in this patient group? Dr. Omar Meziab of The University of Arizona shares his deep insights this week.
https://doi.org/10.1007/s00246-024-03500-1
In this replay episode from 2023, we return to the world of ACHD when we review a recent German research paper on the prevalence of PTSD symptoms amongst the ACHD patient group. How common is this type of symptom observed in the ACHD patient group? What contributes to the high prevalence (17-20.5%) described in this work? What are the benefits of 'embedding' a mental health care worker in the ACHD clinic/program? What strategies can be employed in pediatric cardiology to potentially mitigate PTSD symptoms in our future ACHD patients? These are amongst the many topics reviewed this week with the former Mount Sinai ACHD program clinical social worker, Ms. Meredith Kalbacker who also comments on this week's work. * DOI: 10.1016/j.amjcard.2023.06.087
For those interested, the book referenced by Ms. Kalbacker, Healing Hearts and Minds, can be purchased on Amazon:
https://www.amazon.com/Healing-Hearts-Minds-Holistic-Congenital/dp/0197657281
This week we review a recent work from the team at Seattle Children's Hospital about obstetrical sonography and referral of fetuses with 'suboptimal imaging' for fetal echocardiography. Should all 'suboptimal imaging' cases be referred? How can fetal cardiologists parse out who needs a fetal cardiac scan and when? How does the fetal team in Seattle practically serve a geographic region exceeding 2,000 miles and properly triage the referrals, particularly when 'suboptimal imaging' is the rationale for referral? Associate Professor of Pediatrics at The University of Washington, Dr. Bhawna Arya provides deep insights into her recent work on how to think about fetuses referred for 'suboptimal imaging' as a rationale for fetal consultation.
https://doi.org/10.1007/s00246-024-03495-9
This week we review a recent PHTS study on long-term outcomes following heart transplantation. Why do patients develop coronary vasculopathy and how commonly is it seen at long term follow-up? What factors are associated with better or worse long term outcomes? How do 'adverse childhood experiences' result in worse outcomes for patients? Why do young transplant patients have better long-term outcomes and can this be leveraged to improve older patient outcomes? We speak with the first author of this week's work, Assistant Professor of Pediatrics at Ohio State and also from Nationwide Children's Hospital, Dr. Emily Hayes.
- DOI: 10.1111/petr.70042
This week we review a recent study assessing the rate of hematochezia seen in children following neonatal congenital heart surgery, predominantly for aortic obstruction such as in HLHS. How often is this sign observed in this patient group and what percentage of these patients have actual necrotizing enterocolitis (NEC)? Are there any modifiable risk factors for NEC? How can these data help clinicians separate out those with more benign forms of hematochezia from those with NEC and how might this improve care for this patient group? These are amongst the questions reviewed this week with the work's first author, University of Michigan Assistant Professor of Pediatrics, Dr. Courtney Strohacker.
- DOI: 10.1007/s00246-024-03485-x
For those interested in pediatric podcasts, please take a look at this list of the 'top 15' pediatric topic podcasts - we are #4 in pediatrics for 2025!
https://podcast.feedspot.com/pediatric_podcasts/
This week we review a recent report of 4 patients with serious complications related to either perforation or external compression from the distal tines of the Alterra prestent when used for transcatheter pulmonary valve replacement. We speak with Dr. R. Allen Ligon, interventional cardiologist at Children's Healthcare of Atlanta/Emory University about a recent multicenter report of rare complications seen with this prosthesis. How common are perforations seen with this device and how often are these clinically silent? What should be done for clinically silent prestent perforations? What sort of surveillance of all patients with this device is warranted after successful placement? These are amongst the questions posed to Dr. Ligon and discussed this week.
DOI: 10.1016/j.jaccas.2024.102836
This week we review a report from the teams at University College, Dublin and Texas Children’s Hospital about a collaborative approach to education in which two centers across the globe participate in a shared fellow learning conference. In this conference which is aimed at fellow education, topics are chosen and discussed with facilitated learning from faculty at both sites. What can be gained for fellows on opposite sides of the Atlantic that cannot be learned from exposure to just their one site? How did this approach help fellows learn about how to deal with uncertainty in decision making? How did this trans-continental learning approach enhance patient and team communication? These are amongst the many questions posed to senior cardiologist and senior author of this week’s work, Professor Colin McMahon of University College, Dublin, Ireland.
· DOI: 10.1007/s00246-024-03469-x
This week we review a recent review paper on newest innovations and literature on pacing in pediatric patients and learn a bit about such diverse pediatric pacing topics as:
* Use of the Medtronic Micra device in an off-label manner for epicardial pacing in small infants
* Novel, less invasive approaches to placing epicardial leads in small children
* The role of leadless pacing in the pediatric or CHD patient
* Conduction system pacing in 2025 in the congenital patient
The above are amongst the potpourri of pacing topics that we review with noted congenital electrophysiologist, Dr. Charles Berul of Children's National Hospital in Washington, DC in a co-branded episode with the SADS Foundation. For more information on SADS, please go to their website: SADS.ORG.
- DOI: 10.1016/j.hrthm.2024.02.011
This week we step back in time 3 years ago to review an important cardiac MRI report on Fontan geometry and hemodynamics as measured by computational fluid dynamic analysis. How do factors like Fontan geometry or 'power loss' relate to quality of life for the Fontan young adult patient? How do these data inform imaging in the operating room during these palliations? We speak with the first author of this work, Associate Professor of Pediatrics at U. Penn, Dr. Laura Mercer-Rosa about this important and intriguing work. https://doi.org/10.1016/j.athoracsur.2022.01.017
This week we review a work from the department of cardiology and department of cardiac surgery at Boston Children's Hospital on late hypertension in patients following coarctation repair. Late hypertension has been associated previously with late transverse aortic arch Z score but can this be predicted by the immediate postoperative transverse aortic arch Z score also? What factors account for late hypertension in the coarctation patient? Should more patients have their aorta repaired from a sternotomy? Dr. Sanam Safi-Rasmussen, who is a PhD candidate at Copenhagen University, shares her insights from a work she performed while a research fellow at Boston Children's Hospital.
- DOI: 10.1016/j.jtcvs.2024.08.049
This week we delve into the world of cardiovascular surgery and general cardiology when we review a recent report from UVA on the topic of feeding around the time of neonatal heart surgery. Does preoperative oral feeding improve the chances for 'tube-free' enteral feeds at discharge after heart surgery in small infants? Why might oral feedings improve the chances of discharge oral feedings? How should clinicians think about the known benefits of early CHD surgery for some CHD lesions with the benefits of oral feedings? Dr. Aseel Dabbagh of Children's Mercy Hospital in Kansas City shares her insights into these and other questions.
- DOI: 10.1007/s00246-024-03750-z
This week we review a recent ACTION NETWORK project comparing outcomes of children with CHD who undergo VAD support in comparison to those children with VAD's who do not have CHD. How do morbidity and mortality rates compare between these two cohorts? Why might there be differences in outcomes between these two groups? How are heart failure and transplant cardiologists going to improve outcomes in complex CHD VAD patients in the future? How can all cardiologists make more timely referrals to heart failure and transplant cardiologists for their congenital heart patients? Dr. Shahnawaz Amdani of the Cleveland Clinic provides many insights this week.
- DOI: 10.1016/j.jacc.2024.10.083
In this week's replay episode from 2023, we speak with Associate Professor of Pediatrics at Mount Sinai, Dr. Jennifer Cohen about a recent large scale Fetal Heart Society project she conducted on the topic of fetal ccTGA and outcomes. What observations in fetal life are associated with worse clinical outcomes? Why is it valuable to perform serial fetal echocardiograms in this patient group? How common are genetic or extracardiac abnormalities in this patient group? These are amongst the many questions reviewed with Dr. Cohen this week.
* DOI: 10.1161/JAHA.122.029706
This week we delve into the world of cardiovascular surgery when we review a recent multicenter ("Ross Collaborative") study of long term outcomes of the Ross procedure in newborns and infants. How durable of a repair is this in this young age range? How does the neo-aortic root grow with time? Why might the neo-aorta not dilate in this age group as much as is reported in older patients following the Ross procedure? Who is a candidate for this approach? How are decisions made between aortic valve repair and Ross procedure? Professor David Winlaw who is director of cardiovascular surgery at Lurie Children's Hospital/Northwestern University joins the podcast this week to discuss the results of this multicenter work on this topic of which he is the senior author.
- DOI: 10.1016/j.jtcvs.2024.06.030
This week we review a recent report that asks the question, 'Do all infants who present with SVT require preventive anti-arrhythmic medical therapy?' Who might be a candidate for not using an anti-arrhythmia medication in infancy? What sort of parental education is needed to potentially not use medicine and how do patients not treated compare to those who were treated with anti-arrhythmics in regards to re-admission or presentation to the emergency department or development of tachycardia induced cardiomyopathy? How should parents assess their infants for SVT at home? How long should infants be monitored prior to discharge to home after a single uncomplicated episode of SVT? We speak with Assistant Professor of Pediatrics at Washington University and the first author of this week's work, Dr. Anthony Pompa.
- DOI: 10.1007/s00246-023-03263-1
This week we review a recent large scale, multicenter adult congenital heart study on outcomes of HLHS Fontan patients versus other single RV Fontan patients. How do the two groups compare in regards to thromboembolic risk, risk for arrhythmia or risk for death and heart transplantation? Why might there be differences between these single RV patient groups? How can these results inform management? We speak with Assistant Professor of Medicine and Pediatrics at The Icahn School of Medicine at Mount Sinai, ACHD expert Dr. Kali Hopkins.
doi: 10.1161/JAHA.124.034757. Epub 2024 Nov 27
This week to conclude 2024 we speak with noted investment expert Mr. Paul Merriman to discuss a few topics related to personal finance and investing. First we tackle the notion of having 'enough' to retire. Is there a magic value and how would one think about this? Why is an S&P 500 Index or Total US Stock Market Index a fine 'core' investment and how might one possibly improve upon its performance? What are some of the psychological hurdles we have as investors and potential retirees? Mr. Merriman reviews these and other topics on our end of year episode.
Wishing all a happy and healthy new year to you and your families and loved ones.
Paul Merriman's Website: https://www.paulmerriman.com
Paul's "Quilt" Chart: https://www.paulmerriman.com/12-hidden-lessons-from-investment-history#gsc.tab=0
Paul's "Bootcamp" page: https://www.paulmerriman.com/bootcamp
Last Year's episode of Pediheart was replayed on Mr. Merriman's site: https://www.paulmerriman.com/pediheart-podcast-279-asset-allocation-in-your-retirement-accounts#gsc.tab=0
Paul's book "We're Talking Millions": https://www.paulmerriman.com/free-books#gsc.tab=0
This week we replay episode #203 with Professor Michael Freed of Harvard University, who died this past week. In this episode from 2022 we review his seminal paper on prostaglandin for the treatment of infants with critical congenital heart disease from 1981 and then speak with Dr. Freed about his life, career, the development of PGE1 and more in this wide-ranging interview with this pediatric cardiology pioneer. Dr. Freed shares important career advice as he would to cardiology fellows during his long and illustrious career, advising and shaping the careers of pediatric cardiologists for 5 decades.
doi: 10.1161/01.cir.64.5.899.
This week we delve into preventive cardiology with noted world authority, Associate Professor of Pediatrics, Dr. Carissa M. Baker-Smith of Nemours Health. In the present era, what roles do environment and social determinants of health play in cardiovascular disease? How should practitioners take a family history and how has the family history evolved in modern times? How can clinicians be sure that they are not 'missing' factors when they are trying to screen for cardiovascular disease risk in their patients? What are a few practical changes in how we speak with patients that we can all make to improve our understanding of our patients and their families? An important conversation this week with Dr. Baker-Smith.
https://doi.org/10.1007/s11883-024-01232-4
This week we delve into the world of adult congenital heart disease to review the topic of liver disease in the Fontan patient and specifically, hepatocellular carcinoma (HCC). What is the prevalence of this disease in the Fontan single ventricle adult patient? How effective are scores like the MELD-XI or Fibrosis-4 Index at identification of HCC in the Fontan patient? How should the Fontan adult patient be surveilled for this form of cancer? What evidence is there that earlier identification of HCC is associated with better outcomes? What may prove to be the most important factor in protection of the liver in the Fontan patient? Dr. Yuli Kim, Director of the ACHD program at The University of Pennsylvania shares her deep insights this week into this important topic.
* DOI: 10.1093/eurheartj/ehad788
This week we celebrate the life and career of Dr. Charles Mullins who passed this past week. Dr. Mullins was Professor of Pediatrics at Baylor College of Medicine and one of the pioneers in the world of congenital heart interventional cardiology. In today's episode we will listen back to an episode from 2021 from the SCAI 2021 meeting in which we interviewed Dr. Mullins and Dr. Julie Vincent (then Professor of Pediatrics at Columbia University). Drs. Mullins and Vincent discuss their lives as interventional cardiologists and also speak about the role that mentorship played in their long careers. Dr. Aimee Armstrong of Nationwide Children's Hospital also participates in this conversation. Following this interview replay with Drs. Mullins and Vincent, we speak with Dr. Frank Ing who is the Director of Pediatric Cardiology at UC Davis and the former director of the catheterization lab at Texas Children's and a former trainee and close friend of Dr. Mullins and his family. Dr. Ing shares his memories of training under Dr. Mullins, his thoughts on what was possibly Dr. Mullins' greatest professional contribution and finally speaks about what he learned about being a good mentor from his years with Dr. Mullins.
This week we speak for the entire episode with award winning author Patricia Meisol about her recent book entitled: A Heart Afire: Helen Brooke Taussig's Battle Against Heart Defects, Unsafe Drugs, and Injustice in Medicine. We review Dr. Taussig's early life and the impact it had on her life. Why was there friction between Drs. Taussig and Blalock? What was Dr. Taussig's role in the establishment of the most stringent drug testing rules in the world today? What would Dr. Taussig consider to be her greatest achievement? Was Dr. Taussig the first in our field to understand the notion of social determinants of health? Ms. Meisol reviews this and more in our wide ranging conversation about the extraordinary Professor Helen Taussig. We also share a brief conversation of Dr. Taussig from 1977, speaking about her role in the development of the BTT shunt.
For those interested, Ms. Meisel's book is available:
https://bookshop.org/p/books/a-heart-afire-helen-brooke-taussigs-battle-against-heart-defects-unsafe-drugs-and-injustice-in-medicine-patricia-meisol/19955020?ean=9780262048521
or wherever you get your books!
This week we speak for the entire episode with award winning author Patricia Meisol about her recent book entitled: A Heart Afire: Helen Brooke Taussig's Battle Against Heart Defects, Unsafe Drugs, and Injustice in Medicine. We review Dr. Taussig's early life and the impact it had on her life. Why was there friction between Drs. Taussig and Blalock? What was Dr. Taussig's role in the establishment of the most stringent drug testing rules in the world today? What would Dr. Taussig consider to be her greatest achievement? Was Dr. Taussig the first in our field to understand the notion of social determinants of health? Ms. Meisol reviews this and more in our wide ranging conversation about the extraordinary Professor Helen Taussig. We also share a brief conversation of Dr. Taussig from 1977, speaking about her role in the development of the BTT shunt.
For those interested, Ms. Meisel's book is available:
https://bookshop.org/p/books/a-heart-afire-helen-brooke-taussigs-battle-against-heart-defects-unsafe-drugs-and-injustice-in-medicine-patricia-meisol/19955020?ean=9780262048521
or wherever you get your books!
This week we enter the world of cardiac CT for congenital heart disease reviewing a recent report of a survey of congenital cardiologists who perform congenital heart CT scans. What have been the important trends seen in the past decade beyond expansion in the field in general? Why has the use of the CT scan grown at such a rapid clip? How much radiation does a present day CT scan represent for a patient? How are cardiology fellowships responding to the growing role of this modality in the field? How can we more properly assign accurate relative value units (RVU's) to the significant work effort involved in the performance and reporting of this novel modality. We speak with the first author of this week's work, Assistant Professor of Pediatrics at Weill Cornell, Dr. Rebecca Epstein.
doi: 10.1016/j.jcct.2024.02.002. Epub 2024 Feb 15.
This week we review a recent thought-provoking work on the topic of the dreaded 'pre-authorization' process for procedures being performed in the US. Are there data to support the costs in money and time associated with this process in the world of congenital cardiology? How often are authorizations denied in congenital cardiac cases? Is there any evidence that obtaining insurance pre-authorization improves outcomes? What is the impact of this process on healthcare equity? These are amongst the questions reviewed this week with Dr. Brian Marcus who is a cardiologist and critical care fellow at Children's Wisconsin.
- DOI: 10.1007/s00246-023-03255-1
Pulmonary valve replacement following the arterial switch operation is rare. However, when necessary, how do techniques of transcatheter valve replacement fare for this indication? Why would average outcomes in this setting be less good than in the typical TPVR tetralogy of Fallot patient? How does the presence of stents in the pulmonary arteries in this patient group affect candidacy for TPVR? Are there ways to predict who might be a candidate for a TPVR vs. surgical PVR before coming to the catheterization lab? These are amongst the questions reviewed and posed to Dr. Stephen Nageotte who is the director of the cardiac catheterization laboratory at Loma Linda Children's Hospital in Loma Linda, California.
- DOI: 10.1002/ccd.31152
This week we review a recent large scale study on catecholaminergic polymorphic ventricular tachycardia (CPVT) in children which is based on two large international registries. How do outcomes differ between those symptomatic CPVT patients treated with or without an ICD? Who amongst symptomatic CPVT pediatric patients likely warrant an ICD? What sort of ICD might be optimal - subcutaneous or transvenous? Are there ways to program ICD's in CPVT patients that may reduce inappropriate shocks? Why should the ICD be rarely employed in the CPVT pediatric patient? These are amongst the questions reviewed this week on the podcast. We speak with the work's senior author, Dr. Shubhayan Sanatani who is the chief of pediatric cardiology at BC Children's Hospital in Vancouver, British Columbia, Canada.
doi: 10.1016/j.hrthm.2024.04.006. Epub 2024 Apr 7.
This week we delve into the worlds of cardiac critical care and neurodevelopment when we review a recent report from the team at Children's Hospital of Philadelphia assessing an association between postoperative opioid exposure in infants following CHD surgery and neurodevelopmental outcomes. What might be the biological basis for an association between these 2 factors? How confident can we be that opioid exposure is the factor of importance when there are so many co-variates and variables? We speak with outcomes research expert and interventional cardiologist Dr. Michael O'Byrne about this important and thought-provoking recent work.
- DOI: 10.1016/j.jacc.2024.06.033
This week we listen in on a lecture by Assistant Professor of Pediatrics at the University of Pennsylvania, Dr. Christopher Janson, on the novel agent ivabradine. How does this agent work and in what circumstances can it be used in pediatric arrhythmia management? Is this safe to use for critical arrhythmias despite the fact that it is, at present, only available as an enteral agent? What is the proper dosing regimen with this medication? Dr. Janson answers these and many more questions about ivabradine in this lecture from the Pedirhythm XI conference in Rome, Italy on 9/20/24.
This week we listen in on a wonderful review lecture on fetal arrhythmias by noted fetal cardiologist Professor Bettina Cuneo. In this lecture Dr. Cuneo reviews the basics of fetal tachycardias and bradycardias and how these arrhythmias are diagnosed and sometimes treated. This is a lecture that was delivered on 9/20/24 by Dr. Cuneo at the Pedirhythm XI meeting in Rome, Italy. Thanks go to Dr. Fabrizio Drago and the organizers of Pedirhythm for allowing us to listen in on this wonderful lecture by a world-wide authority.
In this week's replay episode from 2 years ago, we review the important topic of troponin levels in children. What is an abnormal high sensitivity troponin level in children and do the levels vary based upon the assay? What are the differences between high sensitivity troponin I and T levels? Are there differences between boys and girls? Why would using the 97.5%ile upper reference limit result in a more reliable 'line in the sand' in comparison with the more traditional, high sensitivity troponin level cut off of 99th%ile. These are amongst the questions we review with this week's author, Dr. J. Bill McEvoy, Professor of Preventive Cardiology at University of Galway, Ireland.
DOI: 10.1161/CIRCULATIONAHA.122.063281
This week we listen in on a debate from the PICS 2024 Symposium that occurred two weeks ago in San Diego. Today's debate is between master surgeon, Professor of Surgery at UCLA, Dr. Glen S. Van Arsdell taking the position of superiority of primary TOF repair and going up against Dr. Van Arsdell is noted master interventional cardiology expert, Professor of Pediatrics at Baylor College of Medicine, Dr. Athar M. Qureshi. Prepare for a spirited 'debate' between these two experts in their field. Apologies in advance for some sound deficiencies but the orators can be heard clearly enough to allow for an engaging back and forth and learning experience. Has either speaker swayed you? Take a listen!
This week we speak with noted interventional cardiologist Dr. Shyam Sathanandam of LeBonheur Children's Hospital in Memphis, TN about novel, 'off-label' uses of the Amplatzer Piccolo device in children. In what sorts of lesions does Dr. Sathanandam believe this device offers distinct advantages for vascular closure? What is the feature of this device that allows it to work for small defect closure so effectively and safely? Are there any new changes coming to this device or the delivery system for PDA closure in the premature infant? These are amongst the questions and topics reviewed with our guest this week!
https://doi.org/10.1080/14796678.2024.2355057
This week’s episode reviews the notion of the underrepresented in medicine physician and the decision to pursue pediatric cardiology. How would improved representation amongst the congenital heart work force result in better outcomes for patients? How does a diverse workforce foster improved communication with patients? What are some practical steps that can be employed to improve representation in the field? We speak with third year cardiology fellow, Dr. Ogochuckwu M Ezeoke Cox, MD of C.S Mott Children’s Hospital at the University of Michigan about her recent essay on this vital topic.
https://doi.org/10.1007/s00246-023-03144-7
This week we speak with Dr. John Brown who is the Harris B. Schumacker Professor Emeritus of Surgery at the University of Indiana. A congenital heart surgeon for over 45 years, Dr. Brown has performed more than 15,000 pediatric heart operations at Riley Hospital for Children and another 5000 heart operations in adults at IU and Methodist Hospitals. He performed the first pediatric heart transplant in Indiana and developed the first clinical use of the bovine jugular vein and valve for a pulmonary valve replacment in children. He also performed the only known twin to twin newborn heart transplant in the world. He has done and seen it all and has a unique perspective. How did he achieve so much and still have a succesful 56 year marriage to his wife Carol Ann? What is Dr. Brown most proud of in a career that is as prolific as his? What advice would he have have for the next generation? Prepare to be inspired by this master surgeon and friend and colleague of many in our field.
This week we delve into the world of the single ventricle when we speak with Dr. David Hoganson, Assistant Professor of Surgery at Harvard Medical School about a recent work he co-published with investigators from Boston Children’s Hospital on computational fluid dynamic modeling in the planning of the Fontan operation. Single ventricle heterotaxy patients with interrupted IVC are at enhanced risk for the development of pulmonary AVM’s due to flow maldistribution to the pulmonary arteries from the hepatic veins in a Fontan. Can a computational fluid dynamic model predict which operative approach would result in the most balanced hepatic venous flow distribution? Can this reduce the incidence of pulmonary AVM’s? How well did the models predict the actual pulmonary flow measured after surgery on CMR? Who beyond the heterotaxy patient might benefit from this approach? Dr. Hoganson offers us a peek into the world of personalized surgery in this week’s exciting episode.
DOI: 10.1016/j.jacadv.2024.101057
This week we turn back the clocks to re-review a recent research letter from the team at the Harvard Congenital Heart Program about venous insufficiency in the Fontan patient. Why do patients with Fontan circulation develop chronic venous insufficiency and what are the implications of this problem in the Fontan patient? What sort of evaluation should be performed on the Fontan patient presenting with lower extremity venous changes? How worried should the cardiologist be when presented with a Fontan patient with these changes? These are amongst the questions reviewed on this topic with this week's guest, Associate Professor at Baylor University, Dr. Tony Pastor.
JACC Adv 2022 Mar, 1 (1) 100002
This week we delve into the world of heart failure and transplantation when we review a recent PHTS study assessing the impact of ischemic time on outcomes of pediatric heart transplantation. What is considered to be a long ischemic time and what is the impact on outcomes in the pediatric patient undergoing transplant? Why does it appear as the impact of a longer ischemic time is less associated with graft failure in the present era in comparison to the past? What might be the impact of newer heart perfusion devices used to transport organs for transplant? These are amongst the questions reviewed with Professor of Pediatrics at U. Colorado, Dr. Scott R. Auerbach.
- DOI: 10.1016/j.healun.2024.03.002
This week we review a recent report assessing LV function and properties in the Ebstein's anomaly patient using CMR. How often is LV dysfunction observed in the Ebstein's patient who is about to undergo surgical Cone repair? How often did the echo underestimate LV dysfunction in comparison to the 'gold standard' CMR? How often is LV non-compaction observed when using strict criteria in this disease? Can CMR assessment of LV function preoperatively predict postoperative ICU course? These are amongst the questions posed to the first author of this week's work, advanced imaging fellow at U. Pittsburgh, Dr. Aditi Gupta.
https://doi.org/10.1007/s00246-024-03585-8
This week we delve into the world of electrophysiology and review a recent report from the team at Primary Children’s hospital on the use of intravascular ultrasound for EP ablation procedures in children. How is this technology useful for ‘routine’ ablations in kids? Are there some forms of tachycardia where its use is more important than others? How does it lower procedural time or improve efficacy? We speak with Dr. Thomas Pilcher, chief of pediatric electrophysiology at Primary Children’s about his center's recent report in the use of this technology for ablation in children and those with congenital heart disease.
https://doi.org/10.1093/europace/euae047
This past week marked the passing of the great pediatric cardiology pioneer, Dr. Sylvia Griffiths. Dr. Griffiths was a trainee of Dr. Ruth Wittemore of Yale University and was one of the founders of the pediatric cardiology program at NY Presbyterian Hospital in the mid 1950's with Dr. Sidney Blumenthal. Her career spanned 7 decades, all at NY Presbyterian, Columbia University. She is remembered as a pioneering woman in medicine as well as a pioneer as a pediatric cardiologist. She is also remembered as a kind and warm colleague and friend. In today's 304th episode of Pediheart we review a 55 year old paper by Dr. Griffiths on outcomes of partial AV canal repair and speak with the present chief of pediatric cardiology at NY Presbyterian, Dr. Christopher Petit about the important role she played at Columbia. We then speak with Professor of Pediatrics at the Albert Einstein College of Medicine, Dr. Christine Walsh about the role she played in Dr. Walsh's life as well as the lives of so many patients, colleagues and friends. Her imprint will remain and she will always be missed and remembered fondly by all.
- DOI: 10.1161/01.cir.40.1.21
This week we review a recent paper from last 2023 about outcomes of cardiac transplantation in the adult congenital heart patient (ACHD). Little has been written on this topic until this very robust and large scale report. How do single ventricle ACHD patients fair at transplant and how do they compare to non-ACHD heart transplant recipients? Why might 1 and 3 year outcomes not be a 'fair' method of assessing outcomes in this very high risk patient group? How do HLHS patient outcomes compare with other single ventricles? Are there better ways to measure risk in this patient group and how might the data in this work inform risk stratification and management of failing Fontan patients in whom transplantation is being considered? These are amongst the questions posed this week to the week's expert, Dr Daphne Hsu who is Professor of Pediatrics at the Albert Einstein College of Medicine at The Children's Hospital at Montefiore.
https://doi.org/10.1016/j.jacc.2023.06.037
For those interested in learning more about Dr. Hsu, take a listen to episode #166 from June, 2021:
https://www.spreaker.com/episode/pediheart-podcast-166-a-conversation-with-professor-daphne-hsu--45144274
This week we go back in time to 20222 to re-review an episode focusing on gender disparities in salary in the field of congenital electrophysiology. To what degree are female electrophysiologists paid less than their male counterparts despite similar levels of education, work effort and seniority? What interventions could be enacted to help 'mind the gap' and level the playing field in this regard? We speak with the chief of pediatric electrophysiology at The Children's Hospital of Philadelphia, Professor Maully Shah, who is the first author of this week's research letter. doi: 10.1016/j.jacep.2022.02.011
This week's topic is ductal stenting in a low resource environment. We review a recent report from the team at Amrita Institute in Kerala, India about their large, over 10 year experience in ductal stenting. Why has this approach superceded BTTS in this environment? How does the team determine if a patient is a candidate and what morphologies of duct would be inappropriate for intervention? How does the team manage PGE prior to ductal stenting to allow that perfect balance between pulmonary blood flow and ductal constriction to improve procedural success? What can operators in the west learn from the experience of these operators? We review these questions and more with the first author of this work, Dr. Navaneetha Sasikumar who is Associate Professor of Pediatrics at the Amrita Institute.
* DOI: 10.1007/s00246-024-03496-8
This week we review a novel multivariable model used to predict mortality in the repaired tetralogy of Fallot patient. Can this model identify who amongst the repaired TOF patients is at risk for death in the coming years? What are the most important inputs to this model? Why does the use of a validation cohort provide greater strength to this model and is there still room for improvement in the model? Can the data in this work help inform decisions regarding pulmonary valve replacement timing? These are amongst the questions posed to the senior author of this work, Cardiologist-in-Chief at Boston Children's Hospital and Professor of Pediatrics at Harvard University, Dr. Tal Geva.
Novel risk calculator: https://github.com/rTOF-INDICATOR/MORTALITY-RISK-Score
doi: 10.1161/JAHA.123.034871. Epub 2024 Jun 11.
This week we listen in to a wonderful roundtable discussion with 3 of the pioneers in the world of pediatric electrophysiology, namely Dr. John Triedman, Dr. J. Philip Saul and Dr. Edward P. Walsh. All three were 'there at the beginning' and share their memories of how they helped to shape the field of pediatric EP. How did Drs. Walsh and Saul choose to proceed with EP training in a pre-ablation and pre-pediatric EP training era? How did all three decide to start a fellowship program to train the next generation of EP doctors? What sort of 'technology' existed to perform ablations in Boston in the early 1990's and how did these experts come to be the first to perform an RF ablation in any human in Boston? How does the field differ today in comparison to its origins? Amongst their many professional accomplishments, what does each 'guru' view as their greatest professional achievement? These are amongst the many questions posed during a wonderful symposium that was held in Boston on 5/16/24 to celebrate both the 35th anniversary of the EP training program at Boston Children's as well as the milestone birthday of the program's founder, Dr. Edward Walsh.
This week we review a recent editorial commentary from multiple congenital heart surgical leaders in the US today. The topic of their expert opinion piece is the concept of public reporting of results and their 'amplification' through organizations such as US News and World Report, to name one. How has the use of the database from STS been sometimes misinterpreted through public reporting or ranking systems? What was the initial intent of the STS database and how does the present usage of these data differ from the initial intent? Do STS risk adjustment models capture all aspects of risk for patients undergoing surgery and how do deficiencies in this result in unfair 'rankings' of programs? Can we 'take control' of our data and interpret it more clearly and accurately for the public and reduce misusage or misinterpretation of the data? How can public reporting result in improved outcomes? How can 'gaming' of the system be reduced? Dr. Emile Bacha, Professor of Surgery at Columbia University shares his deep insights into a complex and challenging topic.
- DOI: 10.1016/j.jtcvs.2023.03.022
In this week's podcast, we discuss a work that tries to challenge convention when we review a recent work from the team at Emory University about anticoagulation following left sided ablation of SVT in children. A short course of aspirin is commonly prescribed in this setting but what is the evidence for this? How do patients who receive aspirin fare vs. those who do not? Are there some patients in which aspirin might be more 'useful' than others? Is there adequate equipoise to consider a multicenter trial? Is that even necessary? Joining us to discuss this and more about this topic is Dr. Vincent Palmieri, senior electrophysiology fellow at Children's Healthcare of Atlanta.
doi: 10.1016/j.hrthm.2024.01.004.
This week we review a recent large scale, multicenter study of the Pediatric Cardiac Intensive Care Society Investigators on outcomes of pulmonary atresia with intact ventricular septum (PA/IVS) in the present era. How are patients faring in the present era in comparison to the prior 1-2 decades? What are the most important factors to account for improvements observed in survival? Are there subtypes of PA/IVS that warrant early referral to heart transplantation? What is the best predictor of a better outcome and what percentage of PA/IVS patients ultimately have a 2 ventricle repair? Where are the areas for improvement in the coming decade to improve upon these already, improved outcomes? These are amongst the many questions reviewed in this week's episode with the first author, Dr. Ilias Iliopoulos, who is the director of pediatric cardiac critical care at Inova LJ Murphy Children's Hospital.
https://doi.org/10.1007/s00246-022-02954-5
In this replay of our milestone 200th episode of Pediheart, we review a 2005 paper from the team at Nicklaus Children's Hospital on how lactate level was used to monitor oxygen delivery and consumption in the postop congenital heart patient and the impact that a protocol involving frequent monitoring and response to this value improved outcomes in the pediatric CICU. Joining us is the first author of the work, Dr. Anthony Rossi, former chief of cardiology at NIcklaus Children's Hospital. Once again, let's come 'on rounds' with this master of postoperative care to learn how he developed his approach to assessing the pediatric postoperative patient in his quest to identify the right 'goal' of therapy that could potentially mitigate the need only for experience at the bedspace.
doi: 10.1007/s00134-004-2504-1
This week we delve into the world of interventional cardiology and congenital heart surgery when we review a recent report from the team at Toronto Sick Children's Hospital about their experience with interventions in the pulmonary arteries following the arterial switch operation. How often are branch or main pulmonary artery narrowings serious enough to warrant intervention? What degree of RV pressure should warrant a cath or intervention? How commonly did simple balloon dilation result in a meaningful degree of reduction in pulmonary artery obstruction and/or RV pressure? How commonly were complications observed? These are amongst the questions reviewed this week with the work's first author, senior cardiology fellow at the University of Toronto, Dr. Michael N. Gritti.
https://doi.org/10.1007/s00246-024-03408-w
This week we review a report from Italy regarding the observation of RA disk thrombus formation in some patients following GORE Cardioform ASD closure. How common is this complication seen and are there some patient or device characteristics that would be considered higher risk for this complication? How does this information square with the Assured trial data? Why might there be differences between the two data sources? We speak with Associate Professor of Pediatrics at Kravis Children's Hospital at Mount Sinai, Dr. Barry Love who is also Director of the Congenital Cardiac Catheterization Laboratory at Mount Sinai Hospital.
https://doi.org/10.1002/ccd.31002
This week we delve into the world of antibiotic prophylaxis for dental procedures. What are the data to support its use in the congenital heart patient? Why has this been such a difficult topic to study? What do we now know about this topic and what still remains unanswered? Given the low prevalence but dire consequences of this disease, how can investigators consider studying this topic in the future? Is there adequate equipoise to proceed with a randomized controlled trial? We speak with Advanced Imaging Fellow at Boston Children's Hospital, Dr. Francesca Sperotto of Harvard University about her recent multicenter meta-analysis of 30 studies including over one million cases of endocarditis.
- DOI: 10.1001/jamacardio.2024.0873
This week we review a recent work on the use of sodium-glucose cotransporter 2 inhibitors in the ACHD heart failure patient from Europe. Can these agents impact heart failure outcomes in this patient group? What is the mechanism by which they may improve outcomes? Are there data on their effects on the single ventricle patient? What sorts of side effects can be seen and are these more or less commonly observed in the ACHD patient? We speak with the corresponding author of this week's work, Dr. Anastasia Egorova of Leiden University in the Netherlands.
https://doi.org/10.1016/j.jacc.2024.02.017
This week we delve into the world of fetal cardiology when we review a recent large, multicenter study on the impact of prental diagnosis of 22.q11 deletion syndrome. How did the prenatally diagnosed patients differ from those diagnosed postnatally in regards to degree of heart disease and postnatal morbidity and mortality? What is the role of cell-free DNA testing in the screening for patients with this deletion syndrome? How do outcomes differ for this syndrome between the US and other countries and why might this be? These are amongst the many questions reviewed with the first author of this week's work, Dr. Lindsay Freud who is the director of fetal cardiology at Toronto Sick Kid's Hospital and also Associate Professor of Pediatrics at the University of Toronto.
Also joining the podcast this week are the co-directors of this year's Mount Sinai Imaging Symposium entitled: Conversations in Care - The Single Ventricle. Dr. David Ezon, Dr. Jennifer Cohen, Dr. Kenan Stern and Mount Sinai Technical Director and Echo Lab Manager, Ms. Jen Lie Yau share their thoughts about the upcoming conference. This year's symposium will be taking place on May 4th, 2024 and the faculty are a who's who of important pediatric cardiac specialists from the worlds of imaging, interventional cardiology, sonography, surgery and more.
For those interested, you can get more information about this wonderful conference at the following web address:
https://mssm.cloud-cme.com/assets/MSSM/data/Single%20Ventricle%20Symposium24G.pdf
Today's article link:
* DOI: 10.1016/j.ajog.2023.09.005
This week we delve into the world of cognitive bias when we review a recent review of this topic by the team at the University of Arkansas. What are some of the more important common cognitive biases that plague humans and are particularly deleterious for good decision making in 'case management/surgical' conference? What are some approaches to reducing the impact of these biases? How does the advent of ZOOM enhance or reduce bias for surgical conference decisions? We speak with noted authority on this topic, Dr. Joshua Daily who is Associate Professor of Pediatrics at The University of Arkansas in Little Rock for his deep insights into this topic.
https://doi.org/10.1007/s00246-024-03462-4
Other resources mentioned by Dr. Daily include:
- Thinking Fast and Slow by Daniel Kahneman
- Thinking In Bets by Annie Duke
- Predictably Irrational by Dan Ariely
- How To Decide by Annie Duke
This week we review a recent survey study on the topic of junctional rhythm and sinus node dysfunction in the Fontan. How important is this finding in our Fontan patients? When should a patient with a Fontan undergo pacemaker insertion? Is the loss of AV synchrony the more important hemodynamic effect of junctional rhythm or is it chronotropic incompetence? Who should be considered for a possible endocardial, transvenous atrial pacemaker in the Fontan patient? These are amongst the questions posed to this week's guest, noted pediatric electrophysiologist and Professor of Pediatrics at OHSU, Dr. Seshadri Balaji.
https://doi.org/10.1007/s00246-023-03296-6
This week we delve into the world of interventional cardiology and the Fontan when we review a recent report from the Children's Hospital of Philadelphia on the use of the "MitraClip" for the treatment of AV valve regurgitation in the congenital heart patient. Who would be a good candidate for this novel approach? What are the steps in planning or consideration of this technique in a congenital heart patient? How durable is this form of repair? These are amongst the many questions reviewed this week with this week's senior author, Professor of Pediatrics at the Children's Hospital of Philadelphia, Dr. Matthew J. Gillespie.
- DOI: 10.1002/ccd.30935
This week we review an episode from 2022 in the world of cardiac surgery and pediatric pharmacology when we review a work from Australia on levels of cefazolin during and after surgery. Is there an optimal dose regimen that will achieve proper MIC levels of drug? What should the goal of therapy be in regards to MIC levels? Are there novel means of dosing cefazolin? We speak with pediatric critical care pharmacy coordinator at Mount Sinai Kravis Children's Hospital, Dr. Jessica Frye for the pharmacist's perspective on some of these important questions.
https://doi.org/10.1016/j.athoracsur.2022.02.047
This week we review a recent work in the artificial intelligence/deep learning space when we review a recent report from the team at Boston Children's Hospital on a novel model trained to predict LV characteristics in children from the ECG. How does such a program identify LV dilation, dysfunction or hypertrophy from a test (the ECG) not designed to provide most of this information? How well did the model perform when it was tested in a different center entirely? Why is it important to understand how a model of this sort is making its determinations? How might such a model be used clinically? These are amongst the many questions reviewed with the work's first author, Dr. Joshua Mayourian MD, PhD who is a first year cardiology fellow at Boston Children's Hospital.
https://doi.org/10.1161/circulationaha.123.067750
This week we enter the world of the adult congenital heart patient when we discuss Fontan associated liver disease with an ACHD expert, Dr. Katia Bravo-Jaimes of the Mayo Clinic. In this episode we discuss the role of intrahepatic transcriptomics and how genetic analysis of liver biopsy tissue may provide new insights into the pathophysiology of this disease process. How can differential gene expression in the liver of Fontan patients help to explain why some patients have mild versus others severe fibrosis or even frank cirrhosis? Can these insights provide hope for improved surveillance or therapy for this problem? Dr. Bravo-Jaimes provides the answers this week.
https://doi.org/10.1016/j.jacc.2023.12.005
This week we enter the world of the adult congenital heart patient when we discuss Fontan associated liver disease with an ACHD expert, Dr. Katia Bravo-Jaimes of the Mayo Clinic. In this episode we discuss the role of intrahepatic transcriptomics and how genetic analysis of liver biopsy tissue may provide new insights into the pathophysiology of this disease process. How can differential gene expression in the liver of Fontan patients help to explain why some patients have mild versus others severe fibrosis or even frank cirrhosis? Can these insights provide hope for improved surveillance or therapy for this problem? Dr. Bravo-Jaimes provides the answers this week.
https://doi.org/10.1016/j.jacc.2023.12.005
This week we review a recent report from the Boston fetal intervention group about fetal aortic valvuloplasty. What fetal/maternal factors are associated with improved outcomes or technical success of this procedure? What factors are associated with serious adverse events? Who is the 'optimal' candidate for this type of intervention? Why is larger LV size associated with improved technical success? What other types of fetal interventions are being attempted by the Boston team? Drs. Ryan Callahan and Wayne Tworetzky of The Children's Hospital of Philadelphia and Boston Children's Hospital, respectively, share their deep knowledge of fetal intervention this week.
https://doi.org/10.1016/j.jacadv.2024.100835
This week we review a recent report on the development of valvular obstruction due to intimal tissue ingrowth in the Harmony valve. How common is this problem? What factors may predispose a Harmony valve patient to develop this rare complication? Does the location of the valve implant matter in regards to this complication? How should Harmony valves be surveilled? There are amongst the questions posed to this week’s guest, Assistant Professor of Medicine at U. Washington, Dr. Zachary Steinberg.
doi: 10.1002/ccd.30901.Epub 2023 Nov 5.
This week we go back in time to 2019 to re-review an important episode in the world of ACHD and review a registry study assessing outcomes in adults with ASD and elevated PVR who underwent ASD closure. Who was a good candidate for this approach? What were the long term outcomes of this form of therapy? Did ASD closure in this setting confer a survival benefit? We review these and many other questions in a 'virtual roundtable' discussion with Drs. Elisa Bradley, presently of Penn State and Ali Zaidi of Mount Sinai - NYC. Both are world authorities on ACHD and it is a great treat to have such 2 experts both on the show to discuss the subtleties of this complex topic.
doi: 10.1016/j.ijcard.2019.03.056
This week we delve into the world of cardiovascular surgery when we review a recent review of STS data on the pulmonary artery band (PAB). The STS assigns a STAT category of 4 to this operation, denoting higher risk for mortality. Is this warranted? Are all PAB candidates equal? What features are associated with higher or lower mortality rates in patients undergoing banding? Should the data in this work drive innovation to avoid the PAB in some settings? These are amongst the questions posed to the senior author of this week's work, cardiovascular surgeon Dr. Tara Karamlou who is Professor of Surgery at the Cleveland Clinic in Cleveland, Ohio.
DOI: 10.1016/j.athoracsur.2023.09.020
What is the incidence of pediatric out of hosital cardiac arrest and how does it vary depending upon age? What are the most common causes of sudden cardiac arrest in children and what factors can be potentially affected by intevention? What sorts of intervention might reduce rates of sudden cardiac arrest amongst children? Dr. Elizabeth Paratz of St. Vincent's Hospital in Melbourne, Australia, who is an expert in sudden cardiac death, will share her insights into her work and the topic this week.
- DOI: 10.1016/j.hrthm.2023.06.010
In this week's episode we review a recent Dutch study on 50 year follow-up of patients who had ASD repaired at an average age of 7.5 years. How do these patients compare to their middle aged counterparts who did not have congenital heart surgery? Why might the RA or RV be enlarged in these patients, decades after successful ASD closure? How common are arrhythmias seen in this cohort? How common is pulmonary hypertension seen? These are amongst the questions reviewed this week with the work's first author, Dr. Robert Martijn Kauling.
* DOI: 10.1016/j.ijcard.2023.131616
This week we review a recent report from the team at Boston Children's Hospital on outcomes of patients following Stage I palliation for HLHS. When patients are not doing well following this surgery, how important is it to identify surgical problems early in these patients? What are the most common problems encountered when a problem is observed? When a reintervention is performed in this setting, how do patients fare overall and is the timing of the reintervention a factor in overall outcome? Cardiac surgeon and Assistant Professor of Pediatrics at Harvard University, Dr. Meena Nathan shares her insights this week.
doi: 10.1016/j.jtcvs.2022.04.033
Unplanned extubation in the PCICU patient is a serious concern with many untoward associations. Who is at highest risk for this complication? Why is this complication associated with worse outcomes in general? How does race or ethnicity impact the likelihood of this complication? We speak with Assistant Professor of Pediatrics at the University of Cincinnati and pediatric cardiac critical care expert, Dr. Tanya Perry about a recent PC4 registry study on unplanned extubation in the PCICU.
doi: https://doi.org/10.1097/pcc.0000000000003235
To conclude 2023 we end with noted national authority on personal finance and investing, Mr. Paul Merriman. Mr. Merriman reviews some basic ideas about asset allocation within a retirement plan such as a 403b, 401k or IRA with the goal of achieving the highest degree of return for level of risk. He reviews the importance of diversification and also shares with us both a '2 fund' and '4 fund' approach to creating a low cost, efficient and diversified portfolio that has, historically, been associated with good long term returns.
Mr. Merriman's work can be seen at: paulmerriman.com
For those interested learn more about his '2 Fund' solution: https://www.paulmerriman.com/2-funds-for-life-update-2023
For those interested to learn more about his '4 Fund' solution:https://www.paulmerriman.com/4-fund-combo
For those interested in target date funds: https://www.paulmerriman.com/target-date-funds
Finally, for those who did not previously take advantage of Paul's free book, the following is a link to a free PDF of the book: https://irp.cdn-website.com/6b78c197/files/uploaded/Were-Talking-Millions.pdf
Please note: This episode is not intended to provide specific personal finance advice and is for entertainment purposes only. Please consider speaking with a trusted advisor before making any significant changes to your retirement assets.
To conclude 2023 we end with noted national authority on personal finance and investing, Mr. Paul Merriman. Mr. Merriman reviews some basic ideas about asset allocation within a retirement plan such as a 403b, 401k or IRA with the goal of achieving the highest degree of return for level of risk. He reviews the importance of diversification and also shares with us both a '2 fund' and '4 fund' approach to creating a low cost, efficient and diversified portfolio that has, historically, been associated with good long term returns.
Mr. Merriman's work can be seen at: paulmerriman.com
For those interested learn more about his '2 Fund' solution: https://www.paulmerriman.com/2-funds-for-life-update-2023
For those interested to learn more about his '4 Fund' solution: https://www.paulmerriman.com/4-fund-combo
For those interested in target date funds: https://www.paulmerriman.com/target-date-funds
Finally, for those who did not previously take advantage of Paul's free book, the following is a link to a free PDF of the book: https://irp.cdn-website.com/6b78c197/files/uploaded/Were-Talking-Millions.pdf
Please note: This episode is not intended to provide specific personal finance advice and is for entertainment purposes only. Please consider speaking with a trusted advisor before making any significant changes to your retirement assets.
In this replay episode from 5 years ago in 2018, we enter into the world of cardiac morphology and speak with Professor Leo Lopez of Stanford University about a recent work he wrote with the International Society for Nomenclature of Pediatric and Congenital Heart Disease regarding proper nomenclature for VSD's. Is it defect geography or borders that are most important in naming these structures? How was agreement forged between such disparate super-hero experts in cardiovascular medicine and congenital heart disease? Is Dr. Lopez using these designations at the present time? What's next for the nomenclature group? Dr. Lopez shares his insights this week.
As a special treat, Dr. Lopez also sings as the musical coda to today's program. A very special treat indeed and certainly worth replaying! Hoping that all enjoy!
doi: 10.1016/j.athoracsur.2018.06.020
This week we return to the world of ACHD when we review a recent German research paper on the prevalence of PTSD symptoms amongst the ACHD patient group. How common is this type of symptom observed in the ACHD patient group? What contributes to the high prevalence (17-20.5%) described in this work? What are the benefits of 'embedding' a mental health care worker in the ACHD clinic/program? What strategies can be employed in pediatric cardiology to potentially mitigate PTSD symptoms in our future ACHD patients? These are amongst the many topics reviewed this week with the Mount Sinai ACHD program clinical social worker, Ms. Meredith Kalbacker who also comments on this week's work.
- DOI: 10.1016/j.amjcard.2023.06.087
For those interested, the book referenced by Ms. Kalbacker, Healing Hearts and Minds, can be purchased on Amazon:
https://www.amazon.com/Healing-Hearts-Minds-Holistic-Congenital/dp/0197657281
In this week's episode we delve into the world of cardiac catheterization and speak with Assistant Professor of Pediatrics at USC, Dr. Neil Patel about a recent work he co-authored at Children's LA about continuation of anti-coagulation during catheterization. Does AC have to be stopped to safely perform a catheterization? Are there certain cases or patients in whom the risk may be especially high? What about NOACs or DOACs? When should closure devices be considered? These are amongst the questions posed to Dr. Patel this week.
- DOI: 10.1007/s00246-023-03097-x
This week we review a recent work on postoperative ectopic atrial tachycardia (EAT) following congenital heart surgery in children. Are there risk factors for this arrhythmia and are any modifiable? What is the 'go to' therapy used by the electrophysiologists at Children's LA for the acute and chronic treatment of this arrhythmia in the postoperative period? Is the presence of EAT in a postoperative congenital heart patient a marker for a worse outcome? These are amongst the questions posed to Children's of Los Angeles pediatric electrophysiologist, Dr. Jonathan Uniat.
- DOI: 10.1007/s00246-022-03068-8
This week we review the results of the latest update of the Single Ventricle Reconstruction trial, specifically SVR III. How are HLHS patients are faring post Norwood at age 12? What is the overall transplant-free survival rate in this group? Are there differences in survival seen at 12 years between BTTT shunt patients and RV-PA conduit shunt patients? How do they compare in exercise capabilities? What about rates of PLE or arrhythmias seen? Are there interventions that may improve outcomes going forward? These are amongst the questions reviewed this week with the first author, Dr. Caren Goldberg who is Professor of Pediatrics at the University of Michigan.
DOI: https://doi.org/10.1161/circulationaha.123.065192
This week's special episode of Pediheart is a conversation with NYT author James G. Robinson. Mr. Robinson recently released his memoir More Than We Expected: Five Years With A Remarkable Child (Post Hill Press) which reviews the life and times of the Robinson family and their son Nadav who was born with complex single ventricle disease in the setting of heterotaxy syndrome. Nadav lost his life at age 5 but was a blessing to his family and those who knew him. What were some of the characteristics of the better medical communicators that the Robinson's observed? How can parents better advocate for their children during times of critical illness? How can we all bring the 'simple power of human kindness' to our care of children with congenital heart disease? Why is the opinion of the parent so important in delivering optimal care to a child with serious disease? These are amongst the many lessons we take away from Mr. Robinson's book and our conversation this week.
More Than We Expected: Five Years With A Remarkable Child is available on Amazon:
www.amazon.com/More-Than-We-Expected-Remarkable/dp/1637588224
For those interested in learning more about the book, please visit the book's website:
http://morethanamemoir.com/
Finally, for those interested in communicating with Mr. Robinson, he can be reached at:
https://morethanamemoir.com/contact/
This week we delve into the worlds of cardiac critical care and congenital heart surgery when we review a recent report of a randomized controlled trial assessing the impact of nasal intubation on rates of NG or G tube feeds at discharge following neonatal congenital heart surgery. Do nasally intubated patients eat by mouth faster and have shorter lengths of stay? What would be the theoretical reasons that this might be useful? What is an 'ICU Liberation bundle' and how did its application to all postop newborns improve outcomes? Can the route of tracheal intubation truly be viewed as a possible 'modifiable risk factor'? These are amongst the questions posed to cardiology fellow at the Cleveland Clinic, Dr. Melissa Yildirim who conducted this study at the University of Virginia during pediatric critical care fellowship.
doi: 10.1007/s00246-023-03322-7
This week's episode is co-branded with SADS.ORG and is a review of a recent multicenter PACES study on the general outcomes of patients with congenital heart disease who have undergone MRI's. Just how worried should the practitioner be to send a pacemaker or ICD patient for an MRI of any body part? Is there a period of time after implantation when it is safer to proceed with an MRI? What is meant by an MRI conditional device or lead? Does the part of the body imaged matter in regards to risk to CIED's? These are just some of the questions posed to the senior author of this week's work, Dr. Thomas Pilcher of Primary Children's Hospital in Salt Lake City, Utah.
doi: 10.1016/j.hrthm.2023.08.034
For those interested to learn more about the SADS Foundation, please visit their website:
SADS.ORG
In this week's episode we sit down with Professor Jane Newburger of Harvard University to learn a little bit about her life and times. Where did she grow up and who was her inspiration for becoming a doctor and cardiologist? Who were some of the mentors in her professional life? What was it like to work with Dr. Ami Rosenthal or Dr. Alexander Nadas? After such a rich and impactful career and life, what does Dr. Newburger count as her most satisfying and important accomplishments? These are amongst the many questions posed to Dr. Newburger during a live interview from the New England Congenital Cardiology Association (NECCA) in Rockport, Maine that took place on 10.21.23. Also joining the podcast to discuss the organization and its goals and accomplishments is its immediate past president, pediatric cardiac electrophysiologist, Dr. Michael Epstein.
For those interested to learn more about NECCA, please go to their website:
https://necca.wildapricot.org
In this replay episode of 2021, week we review a work on the use of bivalirudin on outcomes of pediatric VAD patients. We speak with Dr. Caroline Carly Heyrend of Primary Children's Hospital in Utah about a recent work she co-authored on time in therapeutic range for this agent in children with VAD's. How does bivalirudin work differently than heparin and what are the theoretical benefits or disadvantages of this agent in comparison with unfractionated heparin? Why are thrombotic complications still common amongst those with pediatric VAD's even when anticoagulation is maintained appropriately? What are the factors at work that make safe anticoagulation so difficult in this complex and fragile group of patients? Dr. Heyrend provides the pharmacist's perspective this week.
DOI: 10.1097/MAT.0000000000001261
This week we delve into cardiovascular surgery when we review a recent report from the Congenital Surgeons' Society on the outcomes of the hybrid approach of pulmonary artery bands for treatment of infants with critical left heart obstructive disease. What risk factors are associated with worse outcomes? Does this approach confer an advantage in comparison to the traditional 'stage I/Norwood' approach to this problem? Does the presence of multiple risk factors worsen outcomes and if so, to what degree? How does the heterogeneity of indications for this approach to obstructive left heart lesions stymie efforts to study this intervention?
- DOI: 10.1016/j.jacc.2023.07.020
Editorial Comment :
- DOI: 10.1016/j.jacc.2023.08.023
This week we discuss the role of the stress echo in the evaluation and follow-up of the patient with Kawasaki disease. What are the present recommendations on the role of this form of imaging in this patient group? What are its benefits and limitations? Can this form of testing provide actionable data beyond imaging such as CT angiography? What is the possible role of CMR in the management and follow-up of the KD patient? Dr. Kirstin Dummer of Rady Children's Hospital shares her deep insights into this endlessly fascinating topic.
- DOI: 10.1007/s00246-022-03037-1
The AHA Scientific Statement On KD:
- DOI: 10.1161/CIR.0000000000000484
This week we delve into the world of fetal cardiology when review a recent report from Nationwide Children's Hospital on the utility of fetal echocardiography in the setting of a negative obstetrical ultrasound and Down syndrome. Down syndrome is associated with congenital heart disease but can the obstetrical ultrasound effectively rule out 'critical' newborn heart disease, obviating the need for a fetal echo, particularly if a postnatal transthoracic scan is planned? Associate Professor of Pediatrics, Dr. Clifford Cua shares his thoughts on this provocative question and work.
doi: 10.1007/s00246-023-03183-0.Epub 2023 Jun 23.
This week we discuss an important 'general cardiology' question - namely, do all exertional chest pain patients need an echocardiogram. In this debate from the World Congress of Pediatric Cardiology and Cardiac Surgery, we hear 2 noted authorities in non-invasive imaging. First up is Dr. Carolyn Altman of Texas Children's Hospital taking the stance that it is indicated in the majority and following Dr. Altman is Dr. Kenan Stern of Mount Sinai Kravis Children's Hospital defending the role of discretion in these decisions and how 'one size may not fit all'. Both authorities provide deep insights into general cardiology and the nuances of evaluating a common cardiology complaint seen in general practice.
This week we delve into the world of interventional cardiology and specifically that of transcatheter valves when we review a recent report on the Harmony valve. How are these valves performing at one year in regards to valvular function? Is frame fracture an issue? What percentage required reintervention? How common was ventricular tachycardia seen? Should patients undergoing these implantations undergo pre-procedural EP studies? We review these questions and more with the first author of this work, noted authority on interventional cardiology, Dr. Matthew J. Gillespie, Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania.
https://doi.org/10.1016/j.jcin.2023.03.002
This week we will hear 2 lectures from the World Congress on ablation in children from two world authorities. In the first, Professor Jeff Kim of Texas Children's Hospital speaks about unusual accessory pathway connections and offers some insights into how to ablate them. Following Dr. Kim, Professor John Papagiannis, chief of cardiology at the Onassis Center in Greece offers us some insights into why some AVNRT is challenging to ablate and how to approach these rare but difficult cases. Why is ablation not 100% effective in children for 'simple' things like accessory pathways or AVNRT? Drs. Kim and Papagiannis provide a few insights into why there is no such thing as 'just AVNRT' or 'just a pathway'.
This week we go back in time 2 years ago and we spend the entire episode speaking with Professor Peter Lang of Harvard University about his rich and long career in pediatric cardiology during one of the most exciting times of the field. Dr. Lang's story includes a virtual who's who of important cardiologists and cardiac surgeons for the past 50 years including Dr. Connie Hayes, Dr. Roberta Williams, Dr. Alexander Nadas, Dr. Richard Van Praagh, Dr. Aldo Castaneda, Dr. Bill Norwood and many, many more. This is a rare opportunity to hear about the development of the Norwood procedure from someone who was at the bedside of the first 30-50 ever performed as well as someone who helped develop the entire field of cardiac critical care. Prepare to be inspired by this towering figure this week.
This week we review a recent large scale assessment of survival amongst patients with CHD who were born between 1980 and 1997 in the US. What percentage of those born with CHD actually survived to age 35? What were the factors associated with improved or worse outcomes? How did those with HLHS fair in this time period? What was the impact of genetic syndromes or non-cardiac abnormalities on outcomes of children with congenital heart disease? We speak with this week's work's first author, CDC epidemiologist, Ms. Karri F. Downing.
https://doi.org/10.1161/circulationaha.123.064400
This week we review a recent work from the UK on the causes of death in adolescents who die suddenly. The novelty of this week's work is that all the individuals in this very large study had specialized cardiac pathologists perform careful assessments of the hearts of these subjects. What is the most common cardiac cause of SCD in the adolescent and how do the findings of this work compare with prior works on this topic? What sort of screening should be considered when encountering a patient with SCD? Why would LVH (without HCM) possibly be a cause of SCD in the young? Should all SCD victims have evaluation by a cardiac pathologist? What is the role of molecular autopsy? These are amongst the many topics reviewed with the senior author of this week's work, noted Professor of Pathology, Dr. Mary Sheppard of St. George's, University of London, London UK.
https://doi.org/10.1016/j.jacc.2023.01.041
This week we travel back in time 2 years to re-review a work from the team at Boston Children's Hospital on the long term outcomes of truncal valves in the setting of truncus arteriosus. Who amongst truncus patients is at risk for the development of truncal regurgitation or a need for reintervention? Are there predictors that might help forecast patients who should be more closely monitored? How do the data in this work help inform the fetal counseling of the team at Boston Children's Hospital? Then instructor in pediatrics, Dr. Laura Gellis, the first author of this week's work, shares her deep insights into this topic this week!
doi: 10.1161/JAHA.120.019104
This week we review a recent fascinating work from the team in Toronto on a novel large mammalian model of HLHS (in fetal lambs). How did the team develop this model and what insights into the development of HLHS has it afforded? How does reduction in inflow to the developing LV result in changes in cellular proliferation in the LV of the fetal lamb? Which is more important in the development of HLHS - genetics or flow patterns? Is this a false dichotomy? Does this novel model provide insights into outcomes thus far observed in fetal interventions for HLHS and aortic stenosis in humans? We speak with the senior author of this week's work, Professor Rajiv Chaturvedi of the University of Toronto about this potentially groundbreaking new model and some of the insights it has provided.
https://doi.org/10.1038/s42003-023-05132-2
This week's episode is a replay from 2019 of a 'co-branded' episode with the SADS Foundation (SADS.ORG) and we speak with the founder and director of Crediblemeds.org, Professor of Medicine Ray Woosley of the University of Arizona. Dr. Woosley speaks with us about how he started the first website dedicated to assessing the evidence for drugs' impact on the QT interval establishing a reliable and trusted website for clinicians and patients to visit to learn about possible drug interactions and their impact on LQTS and the QT interval in general. How was the site first conceived? What are the latest changes on the site? What are the plans for this work going forward? Is grapefruit juice really dangerous? Why does the site request that all have to sign up to access the site? Professor Woosley provides all the answers and more this week!
This week we delve into the world of ACHD when we review a recent important work from the multicenter INDICATOR study group assessing the impact on overall outcomes in TOF patients who have their pulmonary valve replaced. Are survival rates improved by replacement of the pulmonary valve in the TOF patient? What about the effect on ventricular tachycardia? What are the proposed mechanisms by which PVR can positively affect this critical outcomes? Are there differences between transcatheter PVR and surgical in this regard? Is there an RV volume that is the 'sweet spot' for PVR? These are amongst the many questions posed to Professor of Pediatrics and Medicine at Harvard University, Dr. Anne Marie Valente.
https://doi.org/10.1016/j.jacc.2023.02.052
This week we delve into the world of cardiovascular surgery when we check in with the group from Nationwide Children's Hospital and review a novel approach to managing the dreaded LPA stenosis or hypoplasia in the HLHS patient. Why does the LPA seem to be small or stenosed in this condition and how does a preemptive stent address this? Why can't standard PA plasty be used for this particular indication as is used in TOF/MAPCA's? Does one stent size fit all HLHS patients? These are amongst the many questions posed to the first author of this week's work, cardiovascular surgeon Dr. Sergio Carillo.
https://doi.org/10.1016/j.xjon.2022.11.007
This week we delve into the world of electrophysiology and also single ventricle physiology when we review a recent work from the Stanford group on outcomes after the development of ventricular arrhythmias in the single ventricle Fontan patient. Just how worried should the clinician be when these are recorded on ambulatory ECG monitors? What associations exist between these arrhythmias and the use of a Sano shunt? How should the clinician respond to a finding of non-sustained VT in the single ventricle patient? Who is a candidate for an ICD in this setting? These are amongst the questions posed to the first author of this week's work, Clinical Assistant Professor of Pediatrics and electrophysiologist at Stanford University, Dr. Heather Giacone.
doi: 10.1161/CIRCEP.122.011143
In this week's episode, we delve into the world of pediatric heart transplantation and the impact that race or insurance status may have on outcomes. What are the factors that explain worse outcomes for black children waiting for a heart transplant? How is the PHTS Racial Disparity Taskforce working to reduce inequities in this field? What role does insurance status have on these outcomes? We speak with noted heart failure and transplantation expert, Dr. Neha Bansal who is Assistant Professor of Pediatrics at The Icahn School of Medicine at Mount Sinai about this most recent PHTS multicenter study.
* DOI: 10.1016/j.healun.2022.12.002
In this week's first of 2 Pediheart podcast releases, we review the nursing and critical care tracks of the upcoming 8th World Congress of Pediatric Cardiology and Cardiac Surgery coming in late August, 2023. In this collaborative podcast between the Pediheart and PCICS podcasts, hosts Robert Pass, Sadie Rodriguez and Deanna Tzanetos speak with Dr. Amir Ashrafi of CHOC, Bruna Cury of Sao Jose do Rio Preto in Brazil and Dr. Sandra Staveski of UCSF about the upcoming meeting. Dr. Ashrafi, Ms. Cury and Dr. Staveski are on the planning committees and share some of the most exciting aspects of their various tracks in the upcoming meeting.
For more information about the World Congress, please go to the website:
https://www.wcpccs2023.org/event/1da8563e-0f65-486c-88df-70c3db431af5/summary
And don't forget to take a listen to Episode #257 of Pediheart also released today on the topic of fetal cardiology!
In this week's episode we speak with Assistant Professor of Pediatrics at Mount Sinai, Dr. Jennifer Cohen about a recent large scale Fetal Heart Society project she conducted on the topic of fetal ccTGA and outcomes. What observations in fetal life are associated with worse clinical outcomes? Why is it valuable to perform serial fetal echocardiograms in this patient group? How common are genetic or extracardiac abnormalities in this patient group? These are amongst the many questions reviewed with Dr. Cohen in this week's extra special 2 episode release week.
* DOI: 10.1161/JAHA.122.029706
This week's episode is a collaborative episode between the Pediheart and PICS Podcasts and we have 4 guests. Joining us this week are Dr. Carissa Baker-Smith of Nemours Medical Center in Delaware, Dr. Martina Bruekner of Yale University, Dr. Shelby Kutty of Johns Hopkins University and Dr. Jacqueline Sanz of Children's National Hospital. In this week's episode we learn about the general cardiology, imaging, neurodevelopmental and basic science tracks. Each guest representing the planning committee for their respective tracks will share some of the upcoming highlights of this wonderful and comprehensive conference. The list of topics of interest is positively dizzying and you will not want to miss this exciting introduction to some of the more popular tracks coming in late August, 2023!
The World Congress of Cardiology and Cardiac Surgery will take place 8/27-9/1 and information can be obtained about it at this website:
https://www.wcpccs2023.org/event/1da8563e-0f65-486c-88df-70c3db431af5/summary
This week we re-review a work from the large ACHD team in Sydney, Australia regarding outcomes of ACHD patients at age 50. How are these patients progressing from both a medical and psychosocial perspective? What resources are needed to address this rapidly growing population of middle aged ACHD patients? We speak with Professor Rachael Cordina of the University of Sydney about her work on this topic.
doi: 10.1016/j.hlc.2020.05.114
In this week's episode from SCAI 2023, we speak with Professor Kritvikrom Durongpisitikul of Mahidol University, Siriraj Hospital in Bangkok, Thailand about their experience in transcatheter and surgical pulmonary valve replacement (PVR). Who is a candidate for each in the present era? Why was surgery associated with higher mortality rates in this work? Should the criteria for transcatheter PVR differ in comparison with surgery? Dr. Durongpisitikul shares his insights in this live session from SCAI which is co-moderated by Dr. Aimee Armstrong of Children's Nationwide Hospital.
https://doi.org/10.1016/j.jscai.2022.100408
In this week's episode from SCAI 2023, Dr. Aimee Armstrong of Nationwide Children's Hospital joins Dr. Pass in a live session from the annual scientific sessions of SCAI. Professor of Pediatrics at UC Davis, Dr. Frank Ing, reviews his experience with recanalization of central veins in a large pediatric cohort. Who is a candidate for this intervention? When are stents preferred vs. angioplasty alone? Should all patients having central lines removed be evaluated to prevent venous occlusion? What sort of radiation dose is associated with this intervention? Dr. Ing shares his deep knowledge in a live "Pediheart" session from Phoenix, Arizona on 5/19/23 at SCAI 2023.
https://doi.org/10.1016/j.jscai.2022.100547
In this week’s episode we delve into the evidence for digoxin reducing mortality in the interstage period following Norwood palliation for HLHS. We speak with Assistant Professor of Pediatrics at the University of Pennsylvania, Dr. Michael O’Byrne about a recent analysis of the PHIS database using the relatively novel “preference based instrumental variable” approach to analysis of an observational data set. How does this approach allow for possible proof of causation of effect of a variable? Why might digoxin reduce mortality in the HLHS patient following stage I palliation? Are there patients in which the impact of this agent might be greater than others? These are amongst the many questions reviewed this week with Dr. O'Byrne.
https://doi.org/10.1016/j.ahj.2023.05.005
In this week's episode we review the important topic of troponin levels in children. What is an abnormal high sensitivity troponin level in children and do the levels vary based upon the assay? What are the differences between high sensitivity troponin I and T levels? Are there differences between boys and girls? Why would using the 97.5%ile upper reference limit result in a more reliable 'line in the sand' in comparison with the more traditional, high sensitivity troponin level cut off of 99th%ile. These are amongst the questions we review with this week's author, Dr. J. Bill McEvoy, Professor of Preventive Cardiology at University of Galway, Ireland.
DOI: 10.1161/CIRCULATIONAHA.122.063281
This week we delve into a critically important topic which is the mental health of our patients with chronic disease. How common are mental health issues amongst patients with sickle cell disease, cystic fibrosis and congenital heart disease? What accounts for differences in diagnosis or treatment of things like anxiety, depression or ADHD in these different chronic disease state patients? What is structural racism and how does this impact these findings? What is the solution to the under-recognition of mental health disorders in these chronic medcial patients? We speak with ACHD fellow at Texas Children's Hospital and the first author of this week's work, Dr. Vincent J. Gonzalez.
DOI: 10.1016/j.jpeds.2023.113411
Thanks to all who have been listening to the podcast the past 5 years on today's landmark, 250th episode.
This week we delve into the world of adult congenital heart disease when we review a recent work from the ACHD team at UCSF that assesses the impact of BMI on clinical outcomes in the single ventricle adult Fontan patient. What is the cause of elevation in BMI in some Fontan patients? Is obesity the only explanation? Is BMI a modifiable risk factor for our Fontan patients and should exercise be 'prescribed' for these patients? If so prescribed, what type of exercise is best for the Fontan patient? This week's work's senior author, Dr. Anushree Agarwal, Assistant Professor of Medicine at UCSF, shares her insights into this important topic.
DOI: 10.1161/JAHA.122.026732
Also mentioned in today's episode is episode #222 with Dr. Dan Halpern of NYU medical center (https://www.stitcher.com/show/pediheartpediatric-cardiology-today/episode/pediheart-podcast-222-impact-of-cardiac-rehab-on-exercise-tolerance-in-the-achd-patient-206781483)
This week in a replay of a previous co-branded episode with the SADS Foundation (SADS.ORG) from 2.5 years ago, we speak with Professor Peter Schwartz of University of Pavia about a recent work he authored on the topic of changes in repolarization amongst well trained athletes. Can athletic training masquerade as LQTS causing prolongation and/or abnormalities in the QT interval? How can these patients be properly identified and not 'lumped' into the LQTS 'pile'? This is a very important work by one of the foremost authorities on the planet on LQTS and Professor Schwartz also shares with us how he became interested in this topic 50+ years ago as well as some pearls for clinical investigators at the start of their careers. One of the best and most inspirational interviews of the entire nearly 250 episode series!
doi: 10.1161/CIRCULATIONAHA.120.048916
In this episode we speak with Professor of Surgery at the University of Pennsylvania, Dr. Stephanie Fuller about a recent work she co-authored on the impressions of CT surgical trainees and attitudes towards the field of congenital heart surgery. What factors were important amongst those surgeons who chose to pursue the field? What are the obstacles that may make it less appealing to the CT surgical trainee? How can surgeons be effectively trained in this demanding field in an era of public reporting and USNWR rankings? What sort of innovation is happening today to improve the training of congenital heart surgeons? Dr. Fuller shares her deep insights this week.
doi: 10.1053/j.semtcvs.2022.03.004
This week we sit down and speak with living legend of pediatric and congenital cardiology, Dr. Welton Gersony who is Professor Emeritus of Pediatrics at Columbia University. Dr. Gersony was the chief of cardiology for 4 decades at NY Presbyterian Hospital and is the winner of innumerable awards in our field. Today we speak with him about his life, choices and what he loved most about medicine and cardiology. What does he view as maybe his biggest impact? What was it like to work directly with/for Dr. Alexander Nadas? What is Dr. Gersony's relationship to the Kennedy family? All this and more in this fascinating discussion with someone who was there for so much of the beginning of our field and who continues to contribute even to this day.
This week we review a recent report that focuses on the question of whether the direct thrombin inhibitor, bivalirudin is superior to heparin for the small patient with a paracorporeal device both from a medical and financial perspective. Bivalirudin is 40x the cost of heparin but does that capture all of the costs and how does overall cost differ between patients treated with one versus the other agent? We speak with Assistant Professor of Pediatrics at University of Vermont, Dr. Danielle Burstein about a large PHIS database study she recently published on this topic.
* + DOI:
10.1016/j.healun.2022.10.006
Also joining us this week is Assistant Professor of Pediatrics at The Icahn School of Medicine at Mount Sinai, Dr. David Ezon to share with us the exciting news about our upcoming, in person, imaging course entitled: The Right Heart - Conversations In Care. The list of speakers is dizzying and come from the worlds of imaging but also interventions - both surgical and cardiac catheterization. Amongst a cast of many world authorities in the worlds of surgery, intervention and imaging, also joining the fun will be two true giants of cardiology and cardiac pathology, namely Dr. Ira Parness and Dr. Richard Van Praagh.
For those interested, take a look at the website to learn more at:
https://mssm.cloud-cme.com/course/courseoverview?P=5&EID=28135
This week we delve into the world machine learning and decision tree analysis modeling as it is applied to postoperative heart block decisions. Traditional thinking suggests that all congenital heart surgical patients with postoperative heart block should be observed for 7-10 days to allow for possible resolution of conduction block. However, is 7 days truly required in all cases? Are there patients in whom 7 days is not necessary? What could the impact be of earlier pacemaker insertion in these patients? How early can the decision to pace permanently be made and in whom? How does machine learning allow for a potentially more powerful model for this sort of analysis? We speak with Assistant Professor of Pediatrics at The Icahn School of Medicine at Mount Sinai, Dr. Son Duong about an exciting work he co-authored at Stanford University.
DOI: 10.1161/CIRCEP.122.011145
This week's episode of the podcast is supported by the SADS Foundation (SADS.ORG) and is on the topic of the overdiagnosis of LQTS. What sorts of conditions can lengthen the QT interval without true congenital LQTS syndrome? What are the most common errors of ECG interpretation that account for misdiagnosis of this condition and are there leads of the ECG that might help or hurt when attempting to accurately measure the QT interval. What is the role of the ICD in the LQTS patient? We speak with Professor of Pediatrics, Medicine and Pharmacology at the Mayo Clinic Alix School of Medicine, Dr. Michael Ackerman about a recent work he published on this important topic.
doi: 10.1016/j.jacc.2022.11.036.
In this replay episode from 2021, we review a recent work on CMR outcomes pre and post cone reconstruction of the tricuspid valve in Ebstein's anomaly. How durable of a repair is this operation? Is there evidence for ventricular remodeling? Is there an optimal age to perform this surgical procedure? How should arrhythmia risk be assessed prior to surgery? These are amongst the many questions reviewed by and posed to Professor Pedro DelNido of Harvard University. This is a rare opportunity to speak with one of the finest congenital heart surgeons in the world today and a noted expert on the cone repair. doi: 10.1016/j.jtcvs.2020.10.124
This week we review a recent report of a new technique to implant SAPIEN valves for transcatheter pulmonary valve replacement in which 1-3 stents are implanted simultaneously with the SAPIEN valve. What are the potential benefits or disadvantages of this approach and who might be a better candidate for this method? Why is a stent needed outside of the relatively strong SAPIEN prosthesis and how does the team in San Diego choose bare metal vs. covered stents when performing this procedure? We speak with pediatric interventional cardiologist Dr. Jessica Heibel of Pediatrix in San Antonio, Texas about a recent work she co-authored with the team at Rady Children's Hospital in San Diego, California. Dr. Heibel reviews many of the finer points of transcatheter valve implantation this week.
DOI: https://doi.org/10.1016/j.jscai.2022.100553
This week we delve into the world of adult congenital heart disease when we review a recent research letter from the team at the Harvard Congenital Heart Program about venous insufficiency in the Fontan patient. Why do patients with Fontan circulation develop chronic venous insufficiency and what are the implications of this problem in the Fontan patient? What sort of evaluation should be performed on the Fontan patient presenting with lower extremity venous changes? How worried should the cardiologist be when presented with a Fontan patient with these changes? These are amongst the questions reviewed on this topic with this week's guest, Assistant Professor of Clinical Pediatrics (Cardiology) at Yale University, Dr. Tony Pastor. JACC Adv 2022 Mar, 1 (1) 100002
In this week's special episode that is a combination of the Pediheart Podcast and PCICS Podcast, we speak for the entire episode with Professor of Pediatrics Dr. Gil Wernovsky of Children's National. Dr. Wernovsky is the Co-Chair of the upcoming World Congress of Pediatric Cardiology and Cardiac Surgery and shares with us all of the exciting plans for this 'meeting of meetings' that will be staged from August 27th-September 1st in Washington, DC. This is the first World Congress in the US since 1985. Co-hosts Deanna Tzanetos, Jill Zender, David Werho, Lillian Su and Sadie Rodriguez discuss with Dr. Wernovsky why this upcoming meeting will be perhaps the largest congenital heart meeting in history with 'something for everyone'. For those interested, the website for the meeting is:
https://www.wcpccs2023.org
This week we delve into the world of electrophysiology when we review a recent multicenter work on the rare topic of atrial standstill. What is atrial standstill and how does it differ from SA node dysfunction? What risks are associated with this condition and how can they be mitigated? Are there factors in an atrial standstill patient that might prompt implantation of a primary prevention ICD? We speak with the first author of this week's work, Dr. Taylor Howard who is Assistant Professor of Pediatrics at Baylor College of Medicine and an attending physician in pediatric electrophysiology at Texas Children's Hospital about his most recent work.
doi: 10.1016/j.jacep.2022.08.022. Epub 2022 Oct 26.
This week we delve into the world of neonatal congenital heart surgery and review a recent work on changes in the incidence of brain injury following congenital heart surgery. How common is it to see brain injury on the MRI's in this patient group? How have incidences changed over time and what is the likely reason for this? Can the types of inotropic agents used in the postoperative period potentially explain some of the improvements in outcomes that have been observed and what is the proposed mechanism for this? We speak with this week's first author, noted authority on neurodevelopmental outcomes of patients undergoing neontal heart surgery, Associate Professor of Pediatrics at UCSF, Dr. Shab Peyvandi.
DOI: 10.1016/j.jacc.2022.10.029
Editorial accompanying this week's work: DOI: 10.1016/j.jacc.2022.11.027
This week we delve into the world of ACHD when we review a recent work on outcomes of non-cardiac surgery in the ACHD patient. How do ACHD patients fare in comparison to their non-ACHD cohort undergoing non-cardiac surgery? What can be done to improve outcomes in this patient group? We speak with the senior author of this work, Dr. Peyman Benharash, who is Associate Professor of Surgery at UCLA. DOI: 10.1136/heartjnl-2022-321512
Also joining us this week is Dr. Alexandra Lansky of Yale University who is also the Editor-in-Chief of JSCAI which is the newest interventional cardiology journal and the official journal of SCAI. Dr. Lansky shares with us her hopes for the new journal and also the role that congenital interventions will play in this journal. Visit JSCAI.org to see what 'all the fuss' is about!
This week we replay a 2020 episode in which we reviewed a then recent PCCC study assessing outcomes of single ventricle patients who have undergone replacement of the AV or semilunar valve. We speak with Professor Geetha Raghuveer of University of Missouri-Kansas City about this work she co-authored. Outcomes are generally poor in this patient group but are there lessons that can be gleaned from the data regarding optimal timing for repair or replacement of valves in this patient group? This is a great follow-up of episode # 58 from 3.5 years ago. See you next week with a brand new episode! doi: 10.1007/s00246-019-02234-9.
This week we return to the topic of congenital heart surgery when we speak with Dr. John Iguidbashian who is a resident in surgery at U. Colorado. Dr. Iguidbashian reviews a recent paper he co-authored on the topic of the relation of duration of open chest following heart surgery to the development of surgical site infections (SSI). How long is 'too long' when it comes to an open chest and the risk for infection? Is the duration of an open chest following surgery a 'modifiable' risk factor? Are there other factors that might be associated with SSI in this setting other than duration of open chest? Dr. Iguidbashian shares his insights this week. https://doi.org/10.1007/s00246-022-03088-4.
This week we delve into the world of partial heart transplantation when we review a recent paper that discusses the rationale for its potential use in children, particularly in infants. We speak with the work's senior author, Dr. T. Konrad Rajab of the Medical University of South Carolina about the potential benefits of this approach. Who might be a candidate for this approach? What are the theoretical benefits of this approach to transplantation? How many 'partial heart' transplantations have been done to date in the US? What might be different about transplanting 'parts' of hearts rather than entire hearts? Dr. Rajab provides us with his deep insights this week. doi: 10.1111/jocs.17050
This week, to end 2022, we delve into the world of personal finance for the final episode of 2022 when we speak with Mr. Paul Merriman of paulmerriman.com. Mr. Merriman is a world-renowned expert in personal finance and investing who reviews how we might go about funding a newborn child's retirement (in 65 years!) through the magic of index investing, low costs and compounding interest. There are many lessions for all types of investing in this episode.
Mr. Merriman has visited the podcast previously and I would recommend you listen to episodes #146 and 191 for his previous appearances.
For those interested, his website is: https://paulmerriman.com
The articles mentioned are located at: https://paulmerriman.com/the-best-gift-of-all-a-financial-legacy-for-a-child/
and: https://paulmerriman.com/how-10000-will-help-my-newborn-granddaughter-have-a-better-retirement/
For those who have not yet had the chance, you can contact me at pediheart@gmail.com for a pdf copy of his latest book We're Talking Millions: 12 Ways To Supercharge Your Retirement
Finally, for those interested, Mr. Merriman's recommended 'Best in Class ETF's" are located at: https://paulmerriman.com/best-in-class-etf-recommendations/
Mr. Merriman does all of his work as a public service to improve financial literacy amongst the public.
This week we enter the world of cardiogenetics and electrophysiology when we review the topic of catecholaminergic polymorphic ventricular tachycardia (CPVT). Is there a 'best' beta blocker for the treatment of this condition? Why is one better than others? How should one manage the patient who is intolerant of beta blockade but needs it for prevention of arrhythmia? What is the role of flecainide, sympathectomy or even ICD's for these patients? PhD candidate and physician Dr. Puck Peltenburg and CPVT world authority, Dr. Christian van der Werf (both of University of Amsterdam) share their deep insights this week. doi: 10.1161/CIRCULATIONAHA.121.056018. Epub 2021 Dec 7
This week we review a recent important work on outcomes of pregnancy in patients with bioprosthetic valves. What percentage of women entering pregnancy have a dysfunctional bioprosthetic valve? Is there a particular position of valve where the risk of dysfunction is greater for cardiac or fetal events? We speak with noted cardio-obstetrical expert, Dr. Barbara Wichert-Schmitt of Johannes Kepler University in Linz, Austria about her recent work from Canada. doi: 10.1016/j.jacc.2022.09.019
This week we review a recent report from the team at Children's National Hospital in Washington, DC on their experience with the hybrid approach to high risk infants with ductal-dependent systemic circulation. Some patients get ductal stents and others not. How is this decision made? How difficult was it to change the approach of a center that had a reputation for excellence with a more 'traditional/Norwood/Stage I palliative' approach? Are there theoretical advantages to this approach for even 'low risk' patients? We speak with the senior author of this report, Dr. Can Yerebakan who is Associate Professor of Surgery at George Washington University School of Medicine and Health Sciences. doi: 10.1016/j.jtcvs.2021.11.103
This week's episode focuses on gender disparities in salary in the field of congenital electrophysiology. To what degree are female electrophysiologists paid less than their male counterparts despite similar levels of education, work effort and seniority? What interventions could be enacted to help 'mind the gap' and level the playing field in this regard? We speak with the chief of pediatric electrophysiology at The Children's Hospital of Philadelphia, Professor Maully Shah, who is the first author of this week's research letter. doi: 10.1016/j.jacep.2022.02.011
This week we review a recent work from the Precision Medicine For Cardiomyopathy (PRIMaCY) study group on the role of stress testing in the pediatric HCM patient. Does stress testing help identify patients at risk for possible SCD or progression to heart transplantation? Should all pediatric HCM patients undergo this form of testing? What risks are associated with its use and how should these studies be performed? We speak with the first author of this novel multi center study, Associate Professor of Pediatrics Dr. Jennifer Conway of U. Alberta about this 'fresh off the presses' work. https://doi.org/10.1161/circulationaha.122.062699
In this week's replay of a most special 'fellow takeover episode', Dr. Sarah Pradhan, sometime co-host of Pediheart and interventional cardiology fellow at Toronto Sick Children's Hospital, speaks with Professor Roberta Williams of USC about her long and illustrious career as a pioneer in both echocardiography as well as pediatric cardiac critical care. Prepare for a lot of wisdom about career and life from this giant in the fields of pediatric cardiology and pediatrics.
This week we review a recent report from China on transcatheter closure of peri-membranous VSD's with the Amplatzer ADO II device. Reported results are outstanding and this week's report is one of several from China demonstrating efficacy and safety to this approach. Despite this, this procedure is rarely performed in the west. Why might that be? Do we need 'local data' to adopt an approach or can we proceed based upon data from another location where procedural indications may be different? We speak with the director of the cardiac catheterization laboratory at Cincinnati Children's Hospital, Dr. Shabana Shahanavaz about this question based upon her editorial on this impressive Chinese work. doi: 10.1161/JAHA.121.022651 and doi: 10.1161/JAHA.122.024963
This week we delve into the world of cardiac critical care when we review a recent report on an attempt to use a multidisciplinary group of hospital professionals plus parents to design an optimal family meeting structure. How should teams prepare for these meetings? What roles should different care providers play in the team meeting? Is there evidence that a better planned meeting can be more effective in transmitting information and allaying parental fears? We speak with pediatric palliative care expert, Assistant Professor of Pediatrics Dr. Jennifer Walter of The Children's Hospital of Philadelphia about this vital topic. https://doi.org/10.1016/j.jpainsymman.2022.03.010
This week we review a recent cardiac MRI report on Fontan geometry and hemodynamics as measured by computational fluid dynamic analysis. How do factors like Fontan geometry or 'power loss' relate to quality of life for the Fontan young adult patient? How do these data inform imaging in the operating room during these palliations? We speak with the first author of this work, Associate Professor of Pediatrics at U. Penn, Dr. Laura Mercer-Rosa about this important and intriguing work. https://doi.org/10.1016/j.athoracsur.2022.01.017
This week we review a recent international review on the topic of life threatening events occurring during electronic gaming. What risks do video games pose for the typical child or child with an arrhythmia condition? What precautions, if any, should be considered? Are there some sorts of games that are potentially more dangerous than others? We speak with the first and senior authors of this international survey - Dr. Claire M. Lawley of Great Ormand Street, London and Dr. Christian Turner of Sydney Children's Hospital in Sydney, Australia. doi: https://doi.org/10.1016/j.hrthm.2022.08.003.
This week we speak with noted cardiovascular surgeon Dr. John J. Lamberti who is presently Associate Professor of Surgery at Stanford University. Dr. Lamberti's career has spanned from the time of Dr. Robert Gross in the 1960's to present day with Dr. Frank Hanley and the team in Stanford. His career perfectly mirrors the transition from the 'old days' of cardiac surgery up until the present modern age and he shares his reminiscences of working with Dr. Robert Gross, Dr. Aldo Castaneda, Dr. Maurice Lev, Dr. Roberta Williams, Dr. Nadas and others. He also shares his thoughts on how to be a good mentor and what that takes from someone who has mentored many surgeons in the past 5 decades.
This week we review a recent report on the differences between pulse oximeter Sp02 and arterial Sa02. Are there patient specific factors that may result in inaccuracies of measurement? What single ventricular factors may also result in more significant inaccuracies and how should these data be used at the bedside when assessing a child who is cyanosed? We speak with Dr. Cara Pritchett, critical care fellow at Lurie Children's Hospital - Northwestern University about a recent work she co-authored on this important and practical topic. DOI: https://doi.org/10.1016/j.jscai.2022.100394
This week we review a recent work from the team at Stanford University on post-traumatic stress disorder amongst pediatric patients with ICD's as well as their parents. How common is this diagnosis seen amongst these patients and their parents and what are some of the reasons for this? How should patients receiving devices be properly screened for this and why is identification of PTSD so important? Associate Professor of Psychiatry and Behavioral Sciences at Stanford, Dr. Lauren Schneider, shares her insights into her work this week. doi: 10.1016/j.hrthm.2022.06.025
This week's episode is a replay of a co-branded 2020 episode with SADS.ORG and is on the topic of pre-participation screening. Can the ECG offer important benefits vs. the standard 14 point AHA H&P approach? Which approach was more effective in 'real life'? We speak with Professor Robert Campbell of Emory University this week to delve into this contentious and important topic. DOI: 10.1016/j.hrthm.2020.04.032
This week we review a recent work from NYU-Langone on the topic of cardiac rehab for the ACHD patient. Does enrollment in a formal cardiac rehabilitation program result in meaningful improvements in exercise tolerance in the ACHD patient? Who can benefit from this? How does the impact of this form of therapy compare with more traditional medical interventions? We speak with the senior author of this week's work, Associate Professor of Medicine at NYU, Dr. Dan Halpern. DOI: 10.1161/JAHA.121.023896
This week we explore the 'basics' when we review a recent report from the team at the Amrita Institute in Cochin, India on the accuracy and precision of the physical examination in identifying heart disease. How did the stethoscope do in comparison to the 'gold standard' of echocardiography? Is it time to 'retire' the stethoscope or does it still have an honored role in the evaluation of children with possible heart disease? How can physicians and other providers get better at physical examination? Professor Krishna Kumar, chief of the cardiac program at Amrita Institute in Cocchin shares his deep insights this week! https://doi.org/10.1136/bmjpo-2022-001595
This week we review a recent work from Naples, Italy on the use of the GORE Cardioform ASD device to close large atrial septal defects in small children. Are there anatomical 'rules' to help predict who might be a candidate for transcatheter closure? What about this device makes it potentially safer for this indication? Should we be worried about wireframe fractures? We discuss this and other issues related to this topic with the first author of this week's work, interventional cardiologist, Professor Giuseppe Santoro of the University of Naples, Italy. DOI: 10.1111/jocs.16786
This week we delve into the world of bovine jugular vein grafts for the treatment of pulmonary valve dysfunction and the possible enhanced risk for infective endocarditis. How commonly are these valves affected by endocarditis and does placement at surgery in comparison to the cath lab confer a lower risk for this dreaded complication? What factor was most highly associated with the risk for endocarditis with a bovine jugular valve vein graft for PVR? A description from the team at Cincinnati Children's Hospital is on tap this week! https://doi.org/10.1177/21501351211065363
This week we delve into the world of fetal cardiology to review a recent report on fetal SVT. Are there factors in fetal life that would predict postnatal SVT? How should transesophageal pacing factor into decisions in postnatal life? How does the team at Lurie Children’s choose a 2nd agent for fetal SVT when digoxin is ineffective? Are there differences in the clinical presentation of infants prenatally diagnosed with SVT versus those diagnosed after fetal life? We speak with former EP fellow at Lurie Children's Hospital, Dr. Thomas Carberry, who is presently a pediatric electrophysiologist at DeVos Children’s Hospital. https://doi.org/10.1016/j.jacep.2022.06.003
This week we review a landmark paper reviewing the very large experience of Dr. Hanley and his team at Stanford University in managing VSD/PA with MAPCA's. What advantages are seen with the 'midline unifocalization' approach popularized by this team over the past 20+ years? Is this an approach that can be broadly applied or are the technical operative skills too challenging for most? Why are these operations so difficult? How does the Stanford team decide who is a candidate for a single operation and who is not? We explore many of these topics and others with Surgery Professor Richard Mainwaring of Stanford University who is the first author of this important paper published recently in JTCVS. You will not want to miss Dr. Mainwaring's insightful commentary on the challenges and potential benefits of this very complex and painstaking approach. doi: 10.1016/j.jtcvs.2018.03.153.
This week we review a recent work on outcomes of univentricular adult patients who have not been palliated with a Fontan. Do these patients fare better than Fontan patients? What factors are associated with worse or better outcomes? How do these factors inform decision making for the single ventricle adult patient? We speak with adult congenital expert, Dr. Danielle Massarella of University of Toronto about her thoughts on this work and some of its important lessons. DOI: https://doi.org/10.1016/j.cjca.2021.06.001
This week we review an important report on possible racial disparities amongst children on waiting lists for heart transplantation in the US. How did the 2016 changes to the Organ Procurement and Transplantation Network criteria for listing impact outcomes in listed children and unexpectedly widen racial disparities? What impact did these changes have on mortality and outcomes for white vs. non-white children? Why were differences observed? Dr. Mujeeb Zubair of Cedar-Sinai Medical Center in Los Angeles, CA and Dr. Kurt Schumacher of C.S. Mott Children's Hospital in Ann Arbor, MI share their insights this week. We also speak briefly with Dr. John Triedman of Harvard University about the upcoming Pedirhythmx conference coming in September to Boston, MA.
DOI: 10.1161/CIRCULATIONAHA.122.060223
This week we delve into the world of cardiovascular surgery when we review a recent paper from the team at Texas Children's Hospital about the BTT shunt. How commonly did shunts have serious complications? Does the location on the aorta matter in regards to shunt complications? What size shunt is associated with the least morbidity or mortality? Why might shunt placement via a thoracotomy be superior to sternotomy. These are amongst the many questions reviewed with the first author of this work, second year cardiology fellow at Primary Children's Hospital, Dr. Andrew Headrick. DOI: 10.1016/j.athoracsur.2021.11.003
This week we review a recent large scale administrative database study assessing racial and socioeconomic disparities in congenital heart disease outcomes in the US. How does patient neighborhood income affect outcomes? How does the presence of Down Syndrome mitigate risk? How does race or socioeconomic status affect length of stay? How can these data inform change to improve outcomes for all children with CHD? Professor Tara Karamlou of Cleveland Clinic Children's shares her deep insights into this critically important factor that may be every bit as important as the congenital heart anatomy. We also speak briefly in tribute to Dr. James Tweddell of Cincinnati Children's Hospital, who tragically passed last week. DOI: 10.1016/j.athoracsur.2021.04.008
This week we delve again into the controversy regarding optimal newborn management of the symptomatic newborn with tetralogy of Fallot. Does palliation offer a cost savings versus primary repair for the symptomatic TOF patient? What impact does the advent of transcatheter palliative approaches have upon cost? We speak with the first author of this week's work, Assistant Professor of Pediatrics at University of Pennsylvania, Dr. Michael O'Byrne. doi: 10.1016/j.jacc.2021.12.036
This week we turn back to 2020 and delve once more into the world of mental health and review a new large study from the group at Texas Children's on prevalence of anxiety, depression and ADHD amongst the pediatric CHD patient group. How common are these disorders in the young CHD patient and how does this compare to the general pediatric population? What role does minority or insurance status have on diagnosis or treatment of these disorders? Third year cardiology fellow Dr. Vincent J. Gonzalez shares insights from his important work this week. doi: 10.1542/peds.2020-1693
This week we review a recent large claims database study on WPW in children that aims to identify the true incidence of life threatening events in children with this condition. What is known about the incidence of life threatening events as well as the actual prevalence of WPW amongst children? What are the strengths and limitations of large claims database studies? How high is the risk for VF in the WPW child and how should this knowledge inform decisions regarding ablation? Noted expert in WPW, Dr. Christopher Janson of Children's Hospital of Philadelphia shares his insights this week. https://doi.org/10.1016/j.hrthm.2021.12.009
This week we speak with Associate Professor of Pediatrics at University of Washington Sujatha Buddhe of Seattle Children's Hospital about a recent survey study she conducted regarding CMR in the pediatric and congenital heart patient. How have volumes of cases changed over the past few years? Who is reading these studies? What is the advantage of a 1.5T vs. 3.0T scanner for congenital scans? What are the advantages and limitations of a survey study? Dr. Buddhe provides the answers this week. DOI: 10.1186/s12968-021-00830-4
This week we delve into the world of heart transplantation to review a recent article on the topic of outcomes of the Down syndrome patient undergoing heart transplantation. Are infections or cancers more common in this patient group following transplantation? What role does intellectual disability play in the present era in decisions regarding transplantation in this patient group? Associate Professor of Pediatrics at Vanderbilt University, Dr. Justin Godown, shares his insights into this important topic. doi: 10.1161/JAHA.121.024883
This week we play a session of the podcast from SCAI 2022 in Atlanta with Professor of Pediatrics, Columbia University - Dr. Christopher Petit reviewing a recent publication on the topic of systemic sirolimus in concert with catheter interventions for the treatment of pulmonary vein stenosis. Who is a candidate for this sort of therapy? Does systemic sirolimus confer a survival benefit over local stent delivery? Who should be caring for patients with pulmonary vein stenosis? Who is a candidate for transcatheter intervention vs. surgical intervention? Dr. Petit provides the answers in this live session from SCAI 2022. doi: 10.1016/j.jacc.2021.04.013
This week in a live session from SCAI 2022 we hear Assistant Professor of Pediatrics, Dr. Eimear McGovern shares her insights into a recent work she co-authored on changes in Fontan dimensions over time. Who needed interventions and how does the team in Kentucky choose to perform surveillance catheterizations on their Fontan patients? Is there an optimal time? What degree of stenosis or narrowing of a Fontan deserves intervention? Dr. McGovern provides the answers from Atlanta's SCAI Scientific Sessions on 5.21.22. doi: 10.1007/s00246-021-02658-2.
In this replay of episode 92 from 2019, we speak with cardiovascular surgeon Dr. Johann Brink about a recent work he co-authored from the Royal Children's Hospital in Melbourne, Australia about the team's experience with shunt malfunctions. Are there factors that are associated with shunt failure in this sometimes fragile patient group? Survival to Fontan in most series is roughly 70% - what, if anything, can 'move the needle' to higher levels of survival in this patient population? Dr. Brink offers some interesting and important insights this week. doi: 10.1016/j.jtcvs.2019.03.126
This week we review a recent report from Lurie Children's in Chicago on the impact of fetal diagnosis of vascular rings. Does prenatal knowledge of this problem enhance postnatal outcomes? Who deserves cross sectional imaging after birth if prenatally diagnosed with a ring or sling and when and how should this be performed? We speak with Assistant Professor of Surgery at the Mayo Clinic, Dr. Elizabeth Stephens about a recent work she authored on this topic. We also briefly speak with Dr. Kenan Stern about the upcoming, free Mount Sinai Kravis Children's Hospital imaging course that is fast approaching on 5/20/22. DOI: 10.1016/j.athoracsur.2021.01.025
This week we review a recent report from the team at Boston Children's Hospital about a novel approach to avoid heart block during complex congenital heart surgery? Assistant Professor of Pediatrics at Harvard Medical School Elizabeth DeWitt shares with us her insights into a recent report she co-authored by the departments of surgery and cardiology at her institution about intraoperative mapping of conduction. How easy is it to identify the conduction system and how effective at avoiding heart block? Who is a good candidate for this approach? Dr. DeWitt offers her insights as does Dr. John Triedman, Chief of Electrophysiology and a co-author. Dr. Triedman also shares with us information regarding the upcoming PedirhythmX conference that will be held in Boston 9/22-9/24. DOI: 10.1016/j.xjtc.2021.11.017
This week we move into the world of cardiac surgery when we review a recent work from Australia on levels of cefazolin during and after surgery. Is there an optimal dose regimen that will achieve proper MIC levels of drug? What should the goal of therapy be in regards to MIC levels? Are there novel means of dosing cefazolin? We speak with pediatric critical care pharmacy coordinator at Mount Sinai Kravis Children's Hospital, Dr. Jessica Frye for the pharmacist's perspective on some of these important questions. https://doi.org/10.1016/j.athoracsur.2022.02.047
This week we delve into two areas of interest - fellowship training and fetal cardiology when we review a multi-center work endorsed by the Fetal Heart Society on the topic of fetal heart disease counseling. How is this skill taught to cardiology fellows and what are the deficiencies that present exist? Is empathy something that can be taught? What efforts are afoot regarding formalized curricula for this topic? What is the best way to train this critical skill for the cardiologist providing fetal cardiology counseling? We speak with the first author of this week's work, Assistant Professor of Pediatrics at UT Southwestern, Dr. Jenna Keelan. DOI: 10.1007/s00246-022-02882-4
In this week's replay episode we review the important topic of anticoagulation of the Fontan patient. We speak with hematology researcher, Dr. Chantal Attard of The Murdoch Children's Research Institute of The University of Melbourne about a recent cross-sectional study comparing multiple factors in patients with Fontan circulation on aspirin vs. warfarin. What were the demonstrable differences in outcome? Are there ways to make the use of warfarin more safe? What about novel anticoagulants - what is their possible role and what evidence exists for their use in this setting? Dr. Attard provides many key 'takeaways' this week! doi: 10.1016/j.jtcvs.2020.12.102
This week we speak with living legend of cardiology, Dr. Michael Freed about his life and also his landmark paper in 1981 on PGE1. How did Dr. Freed come to conduct one of the first multi center trials of an agent in pediatrics? What was life like in the world of pediatric cardiology prior to PGE1? What is Dr. Freed up to today? What advice does he have for the younger generation? This is a rare opportunity to speak with one of the living legends of our field. DOI: 10.1161/01.cir.64.5.899
This week we review a recent work from the team at NY Presbyterian on SVT and a possible role it may rarely play in sudden cardiac arrest in children. When a patient does not have an obvious cause of arrest, is SVT a possible etiology and should invasive EP testing be considered? We speak with the senior author of this work, Dr. Leonardo Liberman about his thoughts on SVT as a possible cause of arrest and who amongst the many non-pre-excited SVT patients are perhaps 'higher risk'. doi: 10.1007/s00246-021-02720-z
This week we review the concept of stenting the pulmonary veins and we speak with Assistant Professor of Pediatrics at Baylor Medical College, Dr. Melissa Webb about a recent work she co-authored on this topic. Dr. Webb reviews a novel approach to shortening Palmaz stents and then reviews for us the rationale for stenting PV's and also discusses how these patients are longitudinally followed at Texas Children's Hospital. doi: 10.1002/ccd.29984
In this milestone 200th episode of Pediheart, we review a 2005 paper from the team at Nicklaus Children's Hospital on how lactate level was used to monitor oxygen delivery and consumption in the postop congenital heart patient and the impact that a protocol involving frequent monitoring and response to this value improved outcomes in the pediatric CICU. Joining us is the first author of the work, Dr. Anthony Rossi, former chief of cardiology at NIcklaus Children's Hospital. Once again, let's come 'on rounds' with this master of postoperative care to learn how he developed his approach to assessing the pediatric postoperative patient in his quest to identify the right 'goal' of therapy that could potentially mitigate the need only for experience at the bedspace. doi: 10.1007/s00134-004-2504-1
This week's replay episode is co-branded with SADS.ORG and is on the topic of pre-participation screening from 2 years back. Can the ECG offer important benefits vs. the standard 14 point AHA H&P approach? Which approach was more effective in 'real life'? We speak with Professor Robert Campbell of Emory University this week to delve into this contentious and important topic. DOI: 10.1016/j.hrthm.2020.04.032
This week we delve into cardiac surgery and review a recent paper from Rady Children's Hospital about patch material and outcomes in the CHD surgical patient. What are the reasons that glutaraldehyde is used to treat patches used for surgery and what are the potential benefits and disadvantages? What sorts of patches are best for what indications? Are there data to suggest superiority of one patch material versus another? We speak with the senior author of this week's work, Assistant Professor of Surgery at Mount Sinai, Dr. Raghav Murthy about this interesting topic. DOI: 10.1016/j.athoracsur.2020.11.014
This week we review a recent work from Utrecht University in The Netherlands on the topic of postoperative pericardial effusion following congenital heart surgery. Some use steroids, some NSAIDs and some colchicine. Are there any data supporting one agent versus the other? We speak with the first author of this work, Poznan University of Medical Sciences student, Nirmiti Somani about this practical and important issue in congenital heart surgery. DOI: 10.1007/s00246-022-02820-4
This week we delve into the world of the single ventricle patient when we speak with Dr. Adam Lubert of Cincinnati Children's Hospital Center about a recent work he co-authored on MRI imaging of the liver in the Fontan patient. Can simple liver metrics help predict hemodynamics or even outcomes in the single ventricle patient with a Fontan? What is the optimal way to image the liver in this patient group? Are there congenital patients other than Fontan patients who might merit liver imaging? Professor Lubert shares his deep insights this week.
doi: 10.1016/j.amjcard.2021.10.045.
This week we travel back in time to 1991 to review one of the first collaborative projects between Dr. Lisa Hornberger of U. Alberta and the legendary pediatric cardiology investigator, Dr. David Sahn. In this work on tricuspid valve disorders with TR and their diagnosis in fetal life, we learn about our first understandings of this complex physiology and problem and use this as starting point to speak about Professor Sahn, who passed just a few weeks ago. Dr. Hornberger was one of his most important mentees and was inspired to become a fetal cardiologist from her work with this master of echocardiography. Here Dr. Hornberger share her thoughts on Ebstein's anomaly but also Dr. Sahn and the meaningful impact a mentor can have in shaping a person's entire life and career. Prepare to be inspired by the tale of Dr. Sahn and Dr. Hornberger this week. DOI: 10.1016/0735-1097(91)90722-l
In a replay of episode #90 from 2019, we re-review a recent report from the CTOTC-04 study group assessing the impact of novel anti-rejection approaches which generally markedly reduce or remove steroids in the prevention of rejection. How are rejection rates affected by such an approach? Did incidences of diabetes or PTLD differ when using this form of steroid reduced approach in the 'low immunological risk' subset of patients undergoing heart transplantation? We speak with the first author of this work, Professor of Pediatrics, Dr. Jacqueline Lamour of the Icahn School of Medicine at Mount Sinai. Dr. Lamour provides deep insights this week! doi: 10.1016/j.healun.2019.06.006
This week we delve into general pediatric cardiology and discuss those mild abnormalities that are sometimes seen on echo in the newborn nursery. Which of these minor findings in healthy newborns should be monitored and who can be 'discharged' from cardiology follow-up? Are there data to help inform these decisions? Dr. John Hokanson, Professor of Pediatrics, U. Wisconsin, shares his insights this week. DOI: 10.1007/s00246-021-02795-8
This week we review a recent CMR study assessing changes in myocardial fibrosis identified with CMR T1 mapping seen in TOF patients with a single nucleotide polymorphism (SNP) of hypoxia inducible factor 1 alpha. Is myocardial fibrosis in the TOF patient due to hemodynamic factors alone or are there genetic factors that predispose to differences that can be measured on CMR? Professor Lars Grosse-Wortmann of OHSU shares his deep insights into this fascinating topic in which our understanding is rapidly evolving. doi: 10.1016/j.ijcard.2021.12.047
Melody valves have been demonstrated to be associated with a small but consistent rate of endocarditis. Are there factors that might help predict who would need surgical explantation versus those who can be medically managed without surgery? Dr. Arpine Davtyan, senior cardiology fellow at Rady Children's Hospital shares insights from her recent multicenter, retrospective study on this topic. doi: 10.1007/s00246-021-02801-z
Dr. George Ofori-Amanfo, Division Chief of Pediatric Critical Care Medicine in the Jack and Lucy Clark Department of Pediatrics at the Icahn School of Medicine at Mount Sinai and at the Mount Sinai Kravis Children's Hospital, died last week after a very long illness. To honor him, we go back to episode #2 in 2018 in which Professor Ofori-Amanfo shares his insights into the delivery of cardiovascular care in the developing world. Following this interview, the first in the entire Pediheart series, we hear from a large number of prominent nurses, cardiologists, critical care physicians, and surgeons who each offer their appreciations of Dr. Ofori-Amanfo. His impact will be long lasting and he will be missed.
This week's episode, the final of 2021, is on personal finance and we speak with noted personal finance expert Paul Merriman about strategies to improve investing results within a retirement account. Mr. Merriman reviews index funds, the value of these over 'actively managed' funds, and his thoughts on 'target date funds'. Finally, he shares a strategy that may improve the outcome of a target date fund strategy. Here's to a good 2022.
This week we revisit episode 135 where we discussed the topic of mortality attributable to CHD in the US and persistent racial/ethnic disparities over the past 20 years. We speak with Professor Keila Lopez of Texas Children's Hospital about a recent large scale, 'big data' study she co-authored about this topic and review the reasons for these disparities and think about possible remedies. An essential episode on a critically important topic for CHD care. doi: 10.1161/CIRCULATIONAHA.120.046822
This week we delve into the world of congenital heart disease when we review a recent work from the team at Boston Children's Hospital on the long term outcomes of truncal valves in the setting of truncus arteriosus. Who amongst truncus patients is at risk for the development of truncal regurgitation or a need for reintervention? Are there predictors that might help forecast patients who should be more closely monitored? How do the data in this work help inform the fetal counseling of the team at Boston Children's Hospital? Instructor in pediatrics, Dr. Laura Gellis, the first author of this week's work, shares her deep insights into this topic this week! doi: 10.1161/JAHA.120.019104
This week we delve into the coronavirus pandemic and specifically the multisystem inflammatory syndrome in children (MIS-C) following COVID-19 infection. When there was significant initial cardiac involvement seen in the setting of MIS-C, what findings are common in the CMR of patients 6+ months later? How common is delayed enhancement seen and how does this compare with findings seen in other myocarditis patients? Who should be referred for a CMR following MIS-C? Dr. David Barris, 2nd year cardiology fellow at Mount Sinai Kravis Children's Heart Center in NYC and the first author of this week's work, provides the answers this week. DOI: 10.1016/j.jpeds.2021.10.009
This week we turn to a recent work from the group at Texas Children's Hospital about IV sotalol and the treatment of junctional ectopic tachycardia (JET). How did sotalol fair in comparison to IV amiodarone for the treatment of this potentially lethal postoperative arrhythmia? What differences were observed? How should IV sotalol be dosed and who is or is not a candidate? We speak with the first author of this work, Assistant Professor of Pediatrics at The Children's Hospital at Montefiore, Dr. Ellis Rochelson. doi: 10.1016/j.hrthm.2021.11.021
In this week's special 'fellow takeover episode', Dr. Sarah Pradhan, sometime co-host of Pediheart and third year cardiology fellow at Cincinnati Children's Hospital, speaks with Professor Roberta Williams of USC about her long and illustrious career as a pioneer in both echocardiography as well as pediatric cardiac critical care. Prepare for a lot of wisdom about career and life from this giant in the field of pediatric cardiology. An inspirational episode to end the month of November, 2021.
This week we move into the realm of public health for congenital heart care when we review a recent report on a novel approach to tackling the daunting task of enhancing access to care for congenital heart disease to all who need it in a limited resource region. We speak with Ms. Bistra Zheleva of Children's HeartLink and Professor Krishna Kumar of Amrita Institute in Cocchin, India about a recent report on how a large group of professionals have used a private/public cooperative approach based on education and novel modern methods to rapidly care for children with congenital heart disease, resulting in meaningful reductions in infant mortality as well as improvements in care throughout the congenital heart patient lifespan. Prepare to be inspired by this extraordinary tale. DOI: https://doi.org/10.5334/gh.1034
This week we delve into the world of EP when we review a recent work from the team at Rady Children's Hospital on length of treatment for infant SVT. Is there an optimal length of therapy for the infant with SVT? Are there predictors of recurrence that might suggest benefit to a longer course of medical therapy? We speak with Director of Pacing at Rady Children's Hospital, Dr. Matthew R. Williams who is the senior author of this week's work. doi: 10.1007/s00246-020-02534-5
This week we review a recent important work from Germany about the coronary perfusion in patients with HLHS and possible relations between this flow and clinical outcomes. What factors are associated with abnormalities in microvascular coronary flow in the HLHS patient? What anatomical substrate is more concerning for these sorts of problems? Are there factors that might be modifiable that could possibly improve outcomes due to coronary microvascular flow problems in the HLHS patient? How practically easy are CMR studies to assess microvascular coronary flow in the HLHS patient? These are amongst the questions posed this week to Professor Carsten Rickers of University Heart and Vascular Center at the University Hospital Hamburg-Eppendorf. DOI: 10.1161/CIRCIMAGING.121.012468
This week we replay an episode reviewing a large administrative database study from Sweden on risk for cancer amongst patients with CHD. Why are cancer rates different in the CHD patient? What are the most important factors? What actions should be taken by cardiologists caring for ACHD patients in order to properly screen for cancer? We discuss these issues with Assistant Professor of Pediatrics, Harvard Medical School, Dr. Michelle Gurvitz. doi:10.1001/jamanetworkopen.2019.6782
This week we delve into the world of heart transplantation and echocardiography to review a recent work on non-invasive assessment of the pediatric heart transplant patient. Can stress echo and real time myocardial contrast echo identify coronary vasculopathy in this patient group? How do the results compare to coronary angiography? How difficult is this form of imaging and can it be done by pediatric echo techs and staff physicians? Professor Jonathan N. Johnson of the Mayo Clinic shares his insights this week. DOI: 10.1016/j.echo.2020.12.009
This week we delve into the world of cardiovascular surgery to review a recent work on outcomes of arch reconstruction in the newborn and small child. We speak with Dr. Ramana Dhannapuneni, lead cardiac surgeon of Alder Hey Children's Hospital in Liverpool, UK. How often in the present era is re-operation or reintervention required? How common is the recurrent laryngeal nerve or phrenic nerve injured or affected by surgery? Dr. Dhannapuneni provides us with the surgical perspective to this complex surgery this week. doi: 10.1017/S1047951121003747
This week we enter the world of cardiac critical care to discuss delirium in the postoperative pediatric cardiac patient. We speak with nursing scientist, Professor Sandra Staveski of UCSF about a recent large multicenter study she conducted on this topic. How prevalent is this problem and why is it an important morbidity to tackle and reduce? How can nursing interventions reduce this problem and how can the ICU team working together identify and manage this problem? Dr. Staveski shares her deep nursing and critical care knowledge with us this week. DOI: 10.1097/PCC.0000000000002591
This week we review a recent report from the team at Children's Hospital of Los Angeles about prenatal and neonatal factors that might help predict the need for newborn permanent pacing in the setting of antibody-associated CCHB. We speak with Assistant Professor of Pediatrics at Mount Sinai, Dr. Justin Pick about this work. How important is third trimester fetal heart rate in predicting possible need for early pacing? Dr. Pick provides many insights this week. doi: 10.1007/s00246-021-02723
This week we review a recent work on the use of bivalirudin on outcomes of pediatric VAD patients. We speak with Dr. Caroline Carly Heyrend of Primary Children's Hospital in Utah about a recent work she co-authored on time in therapeutic range for this agent in children with VAD's. How does bivalirudin work differently than heparin and what are the theoretical benefits or disadvantages of this agent in comparison with unfractionated heparin? Why are thrombotic complications still common amongst those with pediatric VAD's even when anticoagulation is maintained appropriately? What are the factors at work that make safe anticoagulation so difficult in this complex and fragile group of patients? Dr. Heyrend provides the pharmacist's perspective this week. DOI: 10.1097/MAT.0000000000001261
This week we enter the worlds of fellow education and echocardiography to review a recent report of a QI project performed at Children's Hospital of Philadelphia regarding the performance of echocardiograms by first year fellows in cardiology. Can the implementation of a checklist protocol improve the consistency of echocardiograms performed by fellows? What was the impact of this protocol? What areas were particularly well served by this approach? Dr. Brian White, senior cardiology fellow at CHOP provides important insights into this project that he co-authored. doi: 10.1111/echo.14441
This week we delve into the world of ACHD when we review a recent large data evaluation from the team at Erasmus University in the Netherlands regarding outcomes of DTGA/Arterial Switch patients who have gone through pregnancy. How do these patients fare in general? What sort of pre-pregnancy evaluation should these patients have? Where should their offspring be delivered? Is a maternal fetal medicine expert required for all? Do all DTGA/Switch patients require tertiary care centers? Dr. Karishma Ramlakhan, PhD candidate at Erasmus University shares her deep insights this week. doi: 10.1161/JAHA.120.018176
This week we review a recent work from the team at University of Alabama in Birmingham about clinical outcome disparities amongst Black children with Kawasaki disease. What differences exist in outcomes between these groups and are these differences social or biological in origin? We speak with one of the authors of this work, Assistant Professor of Pediatrics Leslie Collins about this important work. doi: 10.1016/j.jpeds.2020.09.052
From August 2020 - This week we delve into the topic of fellow wellness and review a recent work from the Boston Children's group on fellow fears and stressors when beginning their training. Are there patterns amongst the fellow concerns that can be identified and used to inform interventions to help allay these fears and reduce the stress? We speak with Dr. David Brown, Associate Professor of Pediatrics, Harvard Medical School and also Dr. Tony Pastor who is the ACHD Fellow at Boston Children's Hospital/Brigham and Women's Hospital about their thoughts on fellow fears and stressors as well as fellow (and doctor) wellness. An important topic for our milestone 130th episode. doi: 10.1007/s00246-019-02276-z. Back next week with a new episode!
This week we spend the entire episode speaking with Professor Peter Lang of Harvard University about his rich and long career in pediatric cardiology during one of the most exciting times of the field. Dr. Lang's story includes a virtual who's who of important cardiologists and cardiac surgeons for the past 50 years including Dr. Connie Hayes, Dr. Roberta Williams, Dr. Alexander Nadas, Dr. Richard Van Praagh, Dr. Aldo Castaneda, Dr. Bill Norwood and many, many more. This is a rare opportunity to hear about the development of the Norwood procedure from someone who was at the bedside of the first 30-50 ever performed as well as someone who helped develop the entire field of cardiac critical care. Prepare to be inspired by this towering figure this week.
This week we review a recent work assessing changes in Fontan conduit cross sectional area over time. What accounts for these changes and how do these affect exercise capacity? What does the future hold for the Fontan procedure? Is there an optimal conduit size for patients? We speak with Assistant Professor of Pediatrics at USC, Dr. Neil Patel this week! doi: 10.1016/j.jtcvs.2020.09.140
This week we enter the world of pulmonary hypertension (PH) and review a large multicenter registry study assessing outcomes of the Potts shunt for the management of severe PH. Who is a good or bad candidate for this therapy? Is there an advantage to placement of a valve in the shunt? Does this form of palliation affect lung transplant eligibility? We speak with the first author of this week's paper, Dr. R. Mark Grady, Professor of Pediatrics at Washington University. doi: 10.1016/j.jacc.2021.05.039. For this interested, the organization mentioned this week is ljshealinghearts.com.
This week we enter the world of CT surgery to review a recent STS database study on outcomes of diaphragm paralysis following congenital heart surgery. How common is a diaphragm paralyzed following surgery and what are the main risk factors for this complication? How commonly are these plicated and how do those who are plicated fare in comparison to those managed more conservatively? Professor Narutoshi Hibino of U. Chicago shares his insights this week. doi: 10.1016/j.athoracsur.2020.05.175.
This week we replay an episode that reviews a critically important neurodevelopmental issue affecting infants who have single ventricle palliation - namely hearing loss. How common is hearing loss seen and what role does IV furosemide play in this finding amongst single ventricle patients? Are there techniques to avoid this complication and yet still use this commonly used diuretic agent? We discuss this important issue and study with Dr. Ari Joffe, Professor of Pediatrics University of Alberta - Stollery Children's Hospital who is the senior author of this week's work. doi: 10.1097/PCC.0000000000001807
This week we delve into the world of myocarditis and cardiogenetics when we review a recent work on deleterious cardiomyopathic genes and a possible role for these in patients who have unfavorable myocarditis outcomes. Are cardiomyopathy genes seen more commonly in pediatric patients with myocarditis who die? Is there a role for genetic testing in the myocarditis patient? How might deleterious genetic defects influence outcomes in myocarditis? We speak with Assistant Professor of Medicine at The Icahn School of Medicine at Mount Sinai, Amy Kontorovich who is the first author of this week's work. DOI: 10.1161/CIRCGEN.121.003426
This week we delve into the heart failure and transplantation realm when we review a recent large scale PHIS database study assessing the associations of tracheostomy and outcomes of pediatric heart transplantation. Are tracheostomies associated with worse outcomes or mediastinitis? Who is a good candidate for this therapy? How difficult is it to discuss this option with families and why? These are amongst the questions reviewed with the senior author of this work, Professor Antonio Cabrera of the University of Utah. DOI: 10.1111/petr.13904
This week in our 2nd 'fellow takeover' episode we speak with the inspiring figure, Dr. Elisabeth Martin, who is Assistant Professor of Surgery at Stanford University and one of the cardiovascular surgeons at Lucile Packard Children's Hospital. How did this young surgeon choose to become a cardiac surgeon and what trials and tribulations have accompanied her journey to the highest levels of congenital cardiovascular surgery in the world today? Dr. Sarah Pradhan, 3rd year cardiology fellow at Cincinnati Children's Hospital interviews this up and coming superstar, Dr. Martin. Prepare to be inspired and energized by her story.
This week we review a recent very large scale project from Denmark on the impact of CHD on preterm labor and birth. We speak with Assistant Professor of Pediatrics at Indiana University, Neonatologist Paulomi Chaudhry about the work and her thoughts on what factors may be modifiable in the care of the preterm infant with CHD. What sorts of studies are needed going forward to improve the outcomes of these infants who had CHD but are premature? Dr. Chaudhry provides a number of answers this week! doi: 10.1016/j.jpeds.2020.09.059
This week, in a co-branded episode with SADS.ORG, we speak with Professor Michael Ackerman of The Mayo Clinic about a recent work he published with his team on a novel AI model to assess the ECG for the diagnosis of LQTS. How accurately can this technology identify a patient with LQTS? Can it identify the genetic diagnosis from the ECG alone? What are the implications of this sort of technology in regards to screening patients for LQTS? These are amongst the many topics reviewed with Dr. Ackerman this week on the podcast. doi: 10.1001/jamacardio.2020.7422
This week we delve into the world of noninvasive imaging and review a very novel approach from the team at Stanford University about tele-visits and the use of remote parentally acquired, focused echocardiograms for monitoring of Marfan's patients. Can any parent be trained to perform a focused echocardiogram in their homes? What is the cost associated with this approach? Can this technique be applied to other cardiovascular problems? We speak with Associate Professor of Pediatrics, Seda Selamet Tierney about her recent work on this interesting topic. doi: 10.1016/j.jpeds.2021.01.004
This week's episode is co-hosted by Dr. Sarah Pradhan in our first 'fellow takeover' of the podcast! Dr. Pradhan speaks with Professor Daphne Hsu of Albert Einstein College of Medicine about her career, how she became a heart failure and transplantation authority, how she thinks about mentoring the next generation and also how she balanced a very full life including the highest levels of medicine as well as motherhood. This is an inspirational story by an inspirational figure from whom we all can learn much.
This week we review a recent work from the team at Children's LA about an unusual form of pre-excitation and use this as a place to launch a discussion about pre-excitation. What sorts of pathways cause pre-excitation? Should all pre-excited patients undergo formal testing? Should all pathways be ablated? How can we invasively or non-invasively assess these patients and are these approaches reliable? We have 2 noted experts on this topic - Professor Michael Silka of USC and Professor Steven Fishberger of Spokane, Washington and U. Miami. This is a rare opportunity to hear 2 'gurus' on pediatric electrophysiology 'riff' on a topic about which they each have encyclopedic knowledge. https://doi.org/10.1017/s1047951121000056
This week we review a recent work on CMR outcomes pre and post cone reconstruction of the tricuspid valve in Ebstein's anomaly. How durable of a repair is this operation? Is there evidence for ventricular remodeling? Is there an optimal age to perform this surgical procedure? How should arrhythmia risk be assessed prior to surgery? These are amongst the many questions reviewed by and posed to Professor Pedro DelNido of Harvard University. This is a rare opportunity to speak with one of the finest congenital heart surgeons in the world today and a noted expert on the cone repair. doi: 10.1016/j.jtcvs.2020.10.124
This week we play a live podcast session from SCAI 2021 (April 30, 2021) on the topic of balloon angioplasty for native aortic coarctation in infants aged 3-12 months. We speak with the senior author of this recent work from Toronto Sick Children's Hospital - Professor Rajiv Chaturvedi. How often were complications encountered? How do results compare with surgical repair? Is high pressure required for these dilations? Professor Chaturvedi provides all the answers and more this week! doi: 10.1161/CIRCINTERVENTIONS.120.008938
This week we speak with Professor Eric Rosenthal of Evelina Children's Hospital in London, England from a session at SCAI 2021. Who is a candidate for closure of a superior sinus venosus ASD in the cath lab and how is this determined? If there is a residual shunt, how much is too much? How did Professor Rosenthal embark on this approach and what have been the results? What percentage of these patients are candidates for this novel approach? This is a rare opportunity to have the author present their own data followed by questions from Dr. Pass and Dr. Aimee Armstrong of Nationwide Children's Hospital. https://doi.org/10.1016/j.jacc.2019.12.070
This week we have a special treat in playing a session from the SCAI meeting from today, April 29, 2021! We speak with Professor Julie Vincent of Columbia University and Professor Chuck Mullins of Baylor College of Medicine. Both speak about their early lives, how they chose to become physicians and how life in retirement is treating them. What role did teamwork play in each doctors' professional life? How did Dr. Mullins design the 'Mullins sheath'? These are amongst the many topics we touch upon in this 'slice of life' conversation that was recorded today from the 2021 Scientific Sessions of SCAI which continues through May 1, 2021!
In this replay of episode 80 from 2019, we review a study from The University of Toronto on the impact of timing of the arterial switch operation for DTGA on brain growth and neurodevelopmental outcomes. Can the timing of this surgery impact these outcomes? What is the reason for this? Is it rational to perform this surgery early to improve neurological outcomes? How important is the conduct in the OR versus the ICU? These are amongst the questions we address with Professor Jane Newburger of Harvard University - Boston Children's Hospital this week! doi: 10.1161/CIRCULATIONAHA.118.037495
This week we delve into the world of healthcare disparities and ACHD when we review a recent 'big data' study on levels of insurance coverage amongst ACHD patients and the impact of the affordable care act ("Obamacare") on this metric. To what extent did the enactment of this program increase insurance coverage for ACHD patients? How do their levels of coverage compare with other chronic illness patients such as sickle cell disease or cystic fibrosis? Were all ACHD patients affected similarly from the advent of the ACA? We speak with U. of Michigan ACHD fellow Dr. Katherine Salciccioli about this important work from the group at Texas Children's Hospital. doi: 10.1002/bdr2.1878
This week in a co-branded episodes with the SADS Foundation (SADS.org) we speak with Professor Johannes von Alvensleben of U. Colorado about a recent PACES study on the outcomes of S-ICD's in children and ACHD patients. What are the challenges to their use and who is a good candidate? What is involved in screening patients for an S-ICD and why do children and ACHD patient seem to 'screen out' more than the general population? What are the challenges to their implantation and what is coming down the pipeline in terms of innovation with these devices? Dr. von Alvensleben shares his insights this week. doi: 10.1016/j.jacep.2020.07.010
This week we delve into the world of fetal cardiology to review a recent work on accuracy of fetal echo in the diagnosis of congenital heart disease. We speak with Dr. Namrita Mozumdar of Pediatric Cardiology Of Long Island about her work. What factors are associated with diagnostic discrepancies? DOI: 10.1016/j.echo.2020.06.017
Also joining us is Professor Kenan Stern of Mount Sinai Children's Heart Center to share with us information about the upcoming Mount Sinai Hot Topics In Fetal Cardiology Conference on May 1. Information can be found at:
https://mssm.cloud-cme.com/course/courseoverview?P=3000&EID=4460
This week we review a recent survey study on the topic of aortopulmonary collaterals in single ventricle patients. How often are these occluded in the single ventricle patient and when this is performed, how do interventionalists decide? How should they be occluded? Are there guidelines regarding this? We speak with Professor Ziyad Hijazi of Sidra Cardiovascular Center in Doha, Qatar about this recent work and also briefly discuss the PICS Society for pediatric and adult interventional cardiologists with Dr. Hijazi and Dr. Damien Kenny. doi: 10.1007/s00246-020-02418-8
In this week's replay episode 133, we delve into the world of electrophysiology and ACHD when we review a very recent work on TOF and factors associated with possible risk for sudden death. Can a novel algorithm identify high or low risk patients in this cohort? We speak with Professor Joseph Atallah of The University of Alberta and Dr. Edward Walsh of Harvard University. Both share their deep knowledge in a roundtable discussion this week. DOI: 10.1016/j.amjcard.2020.07.012
This week we explore a recent work assessing the degree of anatomical concordance between neonatologist-performed echocardiograms and those by pediatric cardiology. What is the role of a hemodynamic consultation team in the management of the transitional physiology of the newborn? How do neonatologists use echocardiography in real time to help manage complex physiological problems of the newborn? What training is needed to do this and how does the neonatal team collaborate with cardiology to provide optimal neonatal physiological support and care? We speak with 2 experts to get the perspective of the neonatologist and cardiologist. Senior author and neonatologist Professor Patrick McNamara of University of Iowa and noted cardiac imaging expert, Professor Leo Lopez of Stanford University share their deep insights this week. doi: 10.1016/j.echo.2020.11.005
This week we review the important topic of anticoagulation of the Fontan patient. We speak with hematology researcher, Dr. Chantal Attard of The Murdoch Children's Research Institute of The University of Melbourne about a recent cross-sectional study comparing multiple factors in patients with Fontan circulation on aspirin vs. warfarin. What were the demonstrable differences in outcome? Are there ways to make the use of warfarin more safe? What about novel anticoagulants - what is their possible role and what evidence exists for their use in this setting? Dr. Attard provides many key 'takeaways' this week! doi: 10.1016/j.jtcvs.2020.12.102
This week's work reviews a recent STS database study on airway anomalies and the impact they have on cardiovascular surgical outcomes for congenital heart disease. To what degree does the presence of a concomitant airway surgery impact the morbidity and mortality of congenital heart surgery? Dr. Kyle Riggs, a PGY4 resident in thoracic surgery at Northwell Health shares his insights from his recent publication. doi: 10.1016/j.jtcvs.2020.10.149
This week we delve into the world of general cardiology and echocardiography to evaluate the role of the echo in the evaluation of a palpitation patient. Which pediatric palpitation patients should undergo an echo? What is the yield of this test in this patient group? What is the appropriate evaluation of a palpitation patient and what testing should such a patient undergo? We speak with Dr. Saloni Sheth, 3rd year resident in pediatrics at Rainbow Babies and Children's Hospital in Cleveland, Ohio about a recent work she published on this topic. DOI: 10.1017/S104795112000325X
This week we review a recent work from the large ACHD team in Sydney, Australia regarding outcomes of ACHD patients at age 50. How are these patients progressing from both a medical and psychosocial perspective? What resources are needed to address this rapidly growing population of middle aged ACHD patients? We speak with Professor Rachael Cordina of the University of Sydney about her recent work. doi: 10.1016/j.hlc.2020.05.114
This week we delve back into the world of the Fontan to discuss the fate of the liver in the Fontan patient. We speak with hepatologist, Professor Dellys Soler Rodriguez of Emory University about a recent work she published on the fate of the liver in patients following heart-only transplantation who were Fontan patients. How should these patients be monitored? How should all Fontan patients be monitored? What is the role of the liver biopsy in this evaluation? Dr. Soler Rodriguez provides the insights this week! DOI: 10.1016/j.jpeds.2020.09.044
This week in a co-branded episode with the SADS Foundation (SADS.ORG), we speak with Professor Peter Schwartz of University of Pavia about a recent work he authored on the topic of changes in repolarization amongst well trained athletes. Can athletic training masquerade as LQTS causing prolongation and/or abnormalities in the QT interval? How can these patients be properly identified and not 'lumped' into the LQTS 'pile'? This is a very important work by one of the foremost authorities on the planet on LQTS and Professor Schwartz also shares with us how he became interested in this topic 50+ years ago as well as some pearls for clinical investigators at the start of their careers. One of the best and most inspirational interviews of the entire 150 episode series! doi: 10.1161/CIRCULATIONAHA.120.048916
This week we delve into the world of general pediatric cardiology as well as EP as we review a recent work from the Boston Children's group on management of SVT in the ED. How often are patients admitted to the hospital after conversion of SVT? How frequently are 2nd agents required to terminate SVT beyond adenosine? Why do differences exist in the management of these patients between hospital systems? Boston Children's Hospital cardiology fellow, Dr. Robert Przybylski shares his insights into this week's important and practical work. doi: 10.1007/s00246-020-02515-8
This week we delve into the world of mental health and review a new large study from the group at Texas Children's on prevalence of anxiety, depression and ADHD amongst the pediatric CHD patient group. How common are these disorders in the young CHD patient and how does this compare to the general pediatric population? What role does minority or insurance status have on diagnosis or treatment of these disorders? Third year cardiology fellow Dr. Vincent J. Gonzalez shares insights from his important work this week. doi: 10.1542/peds.2020-1693
This week we speak with Professor Marc Gewillig of University Hospitals, Leuven, Belgium about a recent work he co-authored on the physiology of the Fontan. What is the most important feature of a Fontan circulation in the initial versus late stages after palliation? What constitutes a 'good Fontan'? What is meant by likening the Fontan to a "dam"? Dr. Gewillig provides us with a number of practical concepts in thinking about our Fontan patients and how we might conceptualize possible therapies to improve Fontan flow. doi: 10.1111/apa.15098
This week we speak have 2 special guests. First we check in with Dr. Alin Gragossian, critical care fellow at Mount Sinai Hospital, NYC and also heart transplant recipient. Dr. Gragossian shares with us the details of the past year, her second, with a new heart and what the special challenges have been. Our second guest is investing authority Paul Merriman who is a nationally recognized figure in the world of personal finance and the author of many books on investing as well as the host of his own podcast, 'Sound Investing'. Mr. Merriman shares some of the basics of how to think about asset allocation in a 401K or 403b retirement account. This is a rare opportunity to speak with such a noted expert on this topic and some of his suggestions can literally mean millions in retirement.
As we move on to 2021 and leave 2020 'in the dust', we check in with some of the frontline warriors in the battle with COVID19 and hear their well wishes of inspiration, resilience, warmth and hope. Here's to a wonderful 2021!
This week we review the topic of heart block in the newborn or fetus and review a novel prospective trial assessment of hydroxychloroquine to reduce recurrences of heart block in the offspring of Anti-SSA/Ro-positive mothers. We speak with Professor Jill Buyon and Professor Peter Izmirly, both of NYU Medical Center about a recent multi center trial assessing the impact of this agent for this purpose. How effective was this drug and what if any complications were encountered? What is next in the study of this topic? Drs. Buyon and Izmirly share many insights this week. doi: 10.1016/j.jacc.2020.05.045
This week we review a recent work in the area of medical ethics specifically focused on the notion of comfort care for congenital heart disease. Which diseases or patients should be offered this option and who should not? What sort of agreement is there amongst congenital heart specialists? Who should be involved in such decisions? We speak with Professor Angira Patel of Lurie Children's Hospital about this very important and uncommonly discussed topic. doi: 10.1007/s00246-020-02367-2
Surgery is on tap this week as we discuss a recent paper from the team at Children's Hospital LA about diaphragm plication in the single ventricle patient. What impact did this intervention have on outcomes? How were hemodynamics impacted and did this change outcomes of the bidirectional Glenn or Fontan? What percentage of patients recovered diaphragm function? Professor S. Ram Kumar of USC shares his insights into his recent work with his team.
DOI: 10.1016/j.jtcvs.2020.06.007
This week we review a recent report on the prevalence and types of psychiatric problems that pediatric and adolescent heart failure/transplant patients may have. How common are these illnesses, which are most common and what to do about this? We speak with Assistant Professor of Pediatrics at Vanderbilt University, Dr. Isaura Diaz about her recent work this week. DOI: 10.1016/j.jpeds.2019.10.022
This week we move into the arena of pediatric preventive cardiology and have a somewhat different format to the podcast in that we will be listening to a lecture delivered by Associate Professor of Pediatrics at The Icahn School of Medicine at Mount Sinai - Dr. Joseph Mahgerefteh - speak with us about the topic of familial hypercholesterolemia. He reviews the incidence and consequences of not identifying and managing this properly and many clinical pearls regarding this complex topic. Though a lecture aimed at generalists, this talk is a good introduction to a complex topic. Dr. Mahgerefteh's email is Joseph.Mahgerefteh@mssm.edu for anyone interested in reaching out to ask him any questions they may have regarding this important review this week.
This week we delve into the world of interventional cardiology and speak with Professor Damien Kenny of Children's Hospital, Ireland in Dublin, Ireland about a recent work he co-authored on pre-clinical animal experiments on the use of a novel bioresorbable scaffold/stent. How easy were these to implant? How did these compare with bare metal stents for patency, thrombus or inflammation in the vascular wall? Dr. Kenny shares his insights all the way from Dublin this week!
doi: 10.1002/ccd.28893
This week we delve into the liver once more to review an intriguing report from the group at Johns Hopkins regarding hepatic stiffness in the 2 ventricle congenital heart patient. We know from prior works that single ventricle patients have enhanced liver stiffness but this work suggests that some 2 ventricle patients are also similarly affected. We speak with Professor Ari Cedars of Johns Hopkins University for his insights into these findings and who he thinks might warrant routine liver follow-up in the ACHD patient following congenital heart surgery. doi: 10.1016/j.athoracsur.2020
In this week's episode we replay episode 98 with Professor David Goldberg of Children's Hospital of Philadelphia and the so-called "FONTAN FUEL" trial which assessed the impact of udenafil on measures of exercise in the Fontan patient. This is one of the most important episodes of the 137 series thus far - definitely worth a re-listen. New intro and ending added this week! doi: 10.1161/CIRCULATIONAHA.119.044352
This week's episode is co-branded with SADS.ORG and is on the topic of pre-participation screening. Can the ECG offer important benefits vs. the standard 14 point AHA H&P approach? Which approach was more effective in 'real life'? We speak with Professor Robert Campbell of Emory University this week to delve into this contentious and important topic. DOI: 10.1016/j.hrthm.2020.04.032
This week we enter the world of interventional catheterization to review an important and practical topic which is the notion of blood transfusions during or immediately after catheterization in children with congenital heart disease. We speak with Dr. R. Allen Ligon of Joe DiMaggio Children's Hospital in Hollywood, Florida about a recent work he authored while completing fellowship at Emory University. Are there factors that may help predict the need for blood at cath? Dr. Ligon shares his insights this week! doi: 10.1016/j.jpeds.2019.10.033
This week we discuss the topic of mortality attributable to CHD in the US and persistent racial/ethnic disparities over the past 20 years. We speak with Professor Keila Lopez of Texas Children's Hospital about a recent large scale, 'big data' study she co-authored about this topic and review the reasons for these disparities and think about possible remedies. An essential episode on a critically important topic for CHD care. doi: 10.1161/CIRCULATIONAHA.120.046822
This week we review a recent PCCC study assessing outcomes of single ventricle patients who have undergone replacement of the AV or semilunar valve. We speak with Professor Geetha Raghuveer of University of Missouri-Kansas City about this work she co-authored. Outcomes are generally poor in this patient group but are there lessons that can be gleaned from the data regarding optimal timing for repair or replacement of valves in this patient group? This is a great follow-up of episode # 58 from a year ago. doi: 10.1007/s00246-019-02234-9.
This week we delve into the world of electrophysiology and ACHD when we review a very recent work on TOF and factors associated with possible risk for sudden death. Can a novel algorithm identify high or low risk patients in this cohort? We speak with Professor Joseph Atallah of The University of Alberta and Dr. Edward Walsh of Harvard University. Both share their deep knowledge in a roundtable discussion this week. DOI: 10.1016/j.amjcard.2020.07.012
This week we enter the dual worlds of ACHD and echocardiography to review a recent work from Amsterdam on the use of speckle tracking echocardiography to predict clinical outcomes in the patient with a systemic RV. Can this modality predict a problem prior to more conventional factors or even CMR data? Can this substitute for a CMR? Why is this type of echo more challenging in the systemic RV patient? Dr. Odilia Woudstra shares her deep knowledge of this topic from her research this week! doi: 10.1016/j.cjca.2019.12.014
This week we explore an important paper from CHOP on the optimal approach to repair for Tetralogy of Fallot (TOF). Is there a benefit to a staged approach versus primary complete repair? Are there factors that might influence this decision of approach? We speak with Assistant Professor of Pediatrics Dr. Laura Mercer Rosa of The University of Pennsylvania about her recent large PHIS database study. This is a rare replay episode from last year but one of the very best of the entire series thus far with redone intro and musical endings. doi: 10.1016/j.jacc.2019.05.057.
This week we review a recent work from the C3P0 registry on trans-catheter pulmonary valves. How common were adverse events encountered in this 'real world' assessment? How does this value compare with surgical pulmonary valve replacement? What factors are associated with higher doses of radiation in this procedure? We speak with Dr. Barry Love, Director of the Congenital Catheterization Laboratory at Mount Sinai Kravis Children's Hospital who wrote a very insightful accompanying editorial comment on this paper. doi: 10.1016/j.jacc.2019.11.042
This week we delve into the topic of fellow wellness and review a recent work from the Boston Children's group on fellow fears and stressors when beginning their training. Are there patterns amongst the fellow concerns that can be identified and used to inform interventions to help allay these fears and reduce the stress? We speak with Dr. David Brown, Associate Professor of Pediatrics, Harvard Medical School and also Dr. Tony Pastor who is the ACHD Fellow at Boston Children's Hospital/Brigham and Women's Hospital about their thoughts on fellow fears and stressors as well as fellow (and doctor) wellness. An important topic for our milestone 130th episode. doi: 10.1007/s00246-019-02276-z.
This week we speak with Assistant Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai as well as Chief, Pediatric Cardiology at BronxCare Health System, Dr. Kanika Mathur, about a recent work she co-authored on the topic of enalapril in the single ventricle patient. How safe are these agents in the single ventricle patient? How common were side effects encountered at standard dosing? Dr. Mathur shares her insights from a recent large database analysis study. DOI: 10.1016/j.jpeds.2020.07.058
This week we review a recent report of the novel IV anti arrhythmic agent sotalol. We speak with EP fellow Dr. Alejandro Borquez of Rady Children's Hospital about this agent and where the team at Rady believes it fits in the 'armamentarium' of agents used to treat difficult arrhythmias in children. How effective is the drug for 'regular' SVT or infant atrial flutter? How commonly were adverse events seen with its administration? Dr. Borquez provides the answers this week. doi: 10.1016/j.jacep.2019.11.019
This week we enter the worlds of fellow education and echocardiography to review a recent report of a QI project performed at Children's Hospital of Philadelphia regarding the performance of echocardiograms by first year fellows in cardiology. Can the implementation of a checklist protocol improve the consistency of echocardiograms performed by fellows? What was the impact of this protocol? What areas were particularly well served by this approach? Dr. Brian White, senior cardiology fellow at CHOP provides important insights into this project that he co-authored. doi: 10.1111/echo.14441
This week we delve into cardiac surgery and genetics as we review a recent large dataset study from Drs. Anita Moon-Grady and Laxmi Ghimire who used the KID database to determine the impact of 22q11.2 deletion syndrome on outcomes of repair of TOF and Truncus. Does this syndrome affect mortality or morbidity? If so, why? Professor Moon-Grady of UCSF and Dr. Ghimire of LRGHealthcare provide many insights in this episode. doi: 10.1007/s00246-020-02333-y.
This week we review a fascinating epidemiological study from the University of Ottawa on the impact of assisted reproductive technologies (ART) and twins on the rates of congenital heart disease. What is the more important factor in the development of congenital heart disease - twin pregnancy or ART? Do all ART pregnancies require a fetal echo? We speak with 3 world authorities - epidemiologist Dr. Shi Wu Wen, pediatric cardiologist Dr. Jane Lougheed and fertility expert, Dr. Arthur Leader - all professors at the University of Ottawa. A fascinating topic and discussion! DOI: 10.1001/jamapediatrics.2019.6096
This week we re-review an impressive review of the large Australian/New Zealand registry of Fontan patients assessing the impact of AV valve regurgitation and failure on Fontan outcomes. We discuss this work with the senior author Yves D'udekem, Associate Professor of Surgery at The Murdoch Children's Research Institute and also speak with Professor Frank Cetta of the Mayo Clinic who authored a wonderful editorial on this work. Who is at most risk for AV valve failure at Fontan? How well do patients do with AV valve replacement or repair? We discuss all these issues this week on this exciting episode. doi: 10.1016/j.jacc.2018.12.025
This week we have a very topical episode on the recently identified multi system inflammatory syndrome in children associated with SARS-CoV2 infection (MIS-C). What defines this syndrome and how does it differ from other inflammatory disorders such as toxic shock syndrome or Kawasaki disease? We speak with 2 world authorities - Associate Professor of Pediatrics - Albert Einstein - Dr. Nadine Choueiter as well as Commissioner of Health for NY State - Dr. Howard Zucker. A rare opportunity to speak with a clinician 'on the ground' as well as get a public health perspective from Dr. Zucker who is also a pediatric cardiologist and anesthesiologist. One of the most interesting episodes of the series. doi: 10.1056/NEJMoa2021756 & doi: 10.1056/NEJMoa2021680
This week we review a recent large database study of WPW with particular interest in the patient with intermittent preexcitation. Traditionally, this finding has been considered a sign of low risk. Is this true? Who deserves formal invasive EP testing in this setting? Should all WPW pathways be ablated? These are amongst the many interesting questions discussed with Assistant Professor of Pediatrics - University of Alberta - Dr. Carolina Escudero. doi: 10.1016/j.hrthm.2020.05.035
This week we speak with Professor Robert Hamilton of University of Toronto about a recent potentially groundbreaking work on a novel approach to the diagnosis of Brugada syndrome using an immunological test. How accurate is this test for diagnosis of this often elusive syndrome? Is autoimmunity the cause of disease or are the antibodies just a marker of disease. What's the latest on Professor Hamilton's work on testing for ARVC (reviewed previously in episode 43)? Dr. Hamilton provides us with lots of answers this week. For those interested in collaborating in his studies, his email and that of his research coordinator are in the podcast this week. doi: 10.1093/eurheartj/ehaa383
This week we speak with Professor Marc Gewillig of Leuven, Belgium about a recent paper he co-authored on the topic of the relation of ductal morphology to success at endovascular stenting. Are there some morphologies that are more difficult than others? How is the length of the ductus optimally estimated when choosing a stent length? Dr. Gewillig shares many pearls this week. doi: 10.1002/ccd.28725
This week we review the outcomes of Fontan palliation in the Down Syndrome patient. We speak with Assistant Professor of Pediatrics Dr. Lauren Sarno of East Carolina University about a recent work she co-authored on a complex statistical analysis she performed from the STS database. What accounts for worse outcomes in this patient population? Prepare to be surprised by the information provided this week! DOI: 10.1016/j.athoracsur.2019.07.085
This week we have the rare opportunity to speak for the entire podcast with a pioneer in pediatric heart transplantation and VAD support - Professor James Kirklan of University of Alabama. Dr. Kirklin shares his experiences in forming the PHTS and other organizations devoted to mechanical assist devices in adults and children and how he started the process of multi-institutional studies to answer important questions in surgery and medicine. Dr. Kirklin shares his thoughts regarding the future in this field and also offers some general career and life advice. This is a 'not to be missed' chance to learn from one of the greats of our time in medicine!
This week we replay one of the most listened to episodes of the early part of this podcast history - episode 21 with Dr. Anthony Rossi. Professor Rossi is the Director of Pediatric Cardiology at Nicklaus Children's Hospital in Miami, Florida and is one of the leaders and pioneers in the field of pediatric cardiac critical care. We sit down with Dr. Rossi to review his approach to the assessment and management of the single ventricle patient following stage I palliation. The clinical 'pearls' come fast and furiously from Dr. Rossi - this is one to have pen and paper available to take notes! An inspiring figure to usher out the month of May!
This week we enter the world of cardiovascular anesthesiology to review a recent work from Duke University on the results of the use of IV methadone during cardiac surgery in children. Does this agent result in reductions in postoperative opioid usage while affording similar analgesia? What are the advantages of this agent in this setting? How much should the cardiologist worry about the impact of methadone on the QT interval? We speak with the first author of this work, Assistant Professor of Anesthesiology at UNC, Dr. Annika Barnett. doi: 10.1111/pan.13903
This week we enter into the worlds of fetal cardiology and preventative cardiology to review a recent work from Professor Paul Leeson of Oxford University on the topic of pregnancy induced hypertension and the impact this plays on the cardiovascular health of the offspring. How does this form of HTN affect the structure of the RV and LV in the offspring and why might this explain the increased rates of adult HTN in the offspring of women who were hypertensive during pregnancy? Dr. Leeson provides many interesting insights and context this week. doi: 10.1161/JAHA.119.014586
This week we review a recent work from the team at Mercy Children's on the variability of sheath outer diameter (OD) amongst various sheaths. Can novel 4Fr adult radial sheaths have similar OD to more standard 3.3Fr pediatric sheaths? What are the trade-offs in using a radial sheath for this indication in a newborn? Senior author Dr. Abhay Divekar of Rocky Mountain Pediatric Cardiology shares his insights this week. doi: 10.1002/ccd.28825
On this episode we speak with Professor Edward Walsh of Harvard University about a recent work he co-authored on Ebstein's anomaly. Can review of pathological specimens offer some insights into why ablations in this patient group are so challenging? Is there an optimal age or size to perform an ablation in this patient group? Why are these ablations so difficult? Dr. Walsh, Director of the Arrhythmia Service at Boston Children's Hospital, shares his deep insights this week. doi: 10.1016/j.hrthm.2020.01.013
This week we delve into the world of cardiomyopathy and also stress echo to review a recent work from the team at Boston Children's on stress echo and its role in the assessment of the pediatric HCM patient. We speak with Assistant Professor of Pediatrics Ming Hui Chen of Harvard University about a recent work she co-authored on this modality in children with HCM. Are changes in the LVOT gradient with exercise associated with differences in medium term outcome? Dr. Chen provides the answers this week. doi: 10.1016/j.echo.2020.01.020
This week's episode, co-branded with SADS.ORG, reviews a recent guideline paper by the Mayo Clinic on how to improve the safety of potential COVID-19 therapies such as azithromycin or hydroxychloroquine. These agents can both prolong the QT interval and enhance the risk for torsades making the development of a simple protocol to prevent possible life threatening cardiac side effects critical, particularly in an era before there is strong scientific evidence of efficacy of these agents when used for this indication. Dr. Ackerman shares with us his thoughts on a brief protocol he devised with his colleagues to identify 'at risk' individuals and shares his thoughts on how to thoughtfully consider the risks of these agents when considering their use for COVID-19 therapy. A timely episode with one of the world's greatest authorities on the QT interval in Professor Ackerman. Dr. Ackerman's algorithm is located at https://cdn.prod-carehubs.net/n1/802899ec472ea3d8/uploads/2020/03/2020-COVID-QTc-Algorithm-Internal-and-Media.pdf and the website he mentioned regarding a novel QT calculator for COVID patients is located at: https://www.covidqtc.com .
This week we speak with Professor Candice Silversides of U. Toronto about a recent work she co-authored on the topic of serious cardiac events for women with heart disease. How common are serious cardiac events encountered and what percentage of these are preventable? What is the optimal team for the pregnant patient with heart disease? What are the components of a pre-pregnancy cardiac evaluation? Dr. Silversides provides many insights this week. doi: 10.1016/j.jacc.2020.01.039
This week we delve into the world of preventative cardiology and speak with Associate Professor of Pediatrics at The Albert Einstein College of Medicine, Dr. Joseph Mahgerefteh about a recent work he authored on the impact of obesity and obstructive sleep apnea on hypertension. Which of these factors, which often occur together, is more important in the youth with elevated BP? Dr. Mahgerfeteh shares his insights regarding this week's work while also reviewing a general framework to think about the assessment and approach to obesity in the young. doi: 10.1002/ppul.24693
This week we speak with Dr. Anne Marie Valente, Associate Professor of Medicine and Pediatrics, Harvard University about a recent work she co-authored on the topic of outcomes following PVR and the relation of the RV volume to these. What is the evidence for using RVEDVi as a rationale to replace the pulmonary valve? Does PVR affect long term survival in the TOF patient? What factors are associated with worse long term survival and complications? Dr. Valente is one of the foremost ACHD experts in the world and provides deep insights this week. doi: 10.1016/j.amjcard.2019.12.017.
This week we review a recent paper from the team at the University of Wisconsin regarding weaning from bypass after the Norwood procedure. If there are difficulties in 'coming off', what are the most common problems encountered and what does this difficulty mean for survival and the general hospital course? We speak with the senior author of this work, congenital heart surgeon Dr. Ronald Woods about this somewhat common problem in the OR and how his team manages it. doi: 10.1053/j.semtcvs.2019.08.005
This week we delve into the world of heart failure and transplantation and review a recent report from the ACTION Network about the use of the Heartmate 3 VAD for young patients. Does this device offer advantages over prior durable VAD's? What are the patient size limitations for such a device? Why might this device have fewer complications than prior devices? Dr. Matthew O'Connor, Assistant Professor of Pediatrics at The University of Pennsylvania shares his deep insights with us this week. doi: 10.1016/j.healun.2020.02.007.
This week we review a recent work from the team at Boston Children's Hospital regarding outcomes for patients with complex congenital heart disease who underwent scoliosis repair. We speak with the first author of this work, 2nd year cardiology fellow at Boston Children's, Dr. Robert Przybylski about the work. How should these patients be optimally assessed prior to and then managed during these complex and often challenging surgeries. Dr. Przybylski provides us with great insights this week. doi: 10.1007/s00246-019-02169-1.
This week we replay episode # 40 - a discussion with the inspirational figure, Professor Raman Krishna Kumar of the Amrita Institute in Cochin, India. This master of cardiology reviews how, in a limited resource environment, Professor Kumar was able to develop one of the finest pediatric heart centers in all the world. We will be back with a new episode on 3.6.20!
This week we move into the world of the CICU to review a recent work on the use of noninvasive means of ventilation following congenital heart surgery. How often does this form of ventilation prevent a child with respiratory failure avoid reintubation? What is the evidence for the benefit of this? Are we extubating patients too soon? We speak with Ms. Denise Rolim who is a highly experienced pediatric physiotherapist in the PICU of Hospital Sirio-Libanes in Sao Paulo, Brazil and who is also the first author of this week's work. A true international episode this week! doi: 10.1007/s00246-020-02290-6
This week we review a recent work on the prevalence of adverse events when starting sotalol in the pediatric patient with arrhythmias. How commonly were problems encountered? Does initiation always require hospitalization and monitoring in an inpatient setting or are there some patients who might be candidates for an outpatient approach? Is there a level of dysfunction that would preclude its use? Assistant Professor of Pediatrics at Northwestern University, Dr. Stephanie Chandler, provides insights into her work from the group at Boston Children's Hospital. Also featured is a brief discussion with Dr. Jack Rychik of Children's Hospital of Philadelphia regarding the CHOP2020 course and next year's CHOP2021. doi: 10.1016/j.hrthm.2020.01.022
The innocent heart murmur is the topic of this week's podcast. How important is the echocardiogram in allaying parental fears and anxieties when being evaluated for a murmur? Have the days of auscultation without a secondary test fallen by the wayside? We speak with a highly experienced general pediatric cardiologist, Dr. Jared LaCorte of Staten Island Pediatric Cardiology to offer his thoughts on this week's work from Melbourne, Australia. doi: 10.1111/jpc.14775
This week we delve into global pediatric cardiology and review a massive and important work from the Global Burden of Disease study group assessing the trends in congenital heart disease in the world from lower income nations to higher. How has the prevalence of congenital heart disease changed over the past 30 years? How are countries faring in their treatment of congenital heart disease? What are some strategies to address global inequities in care? We discuss these and other questions with the corresponding author of this work, Professor Craig Sable of George Washington University. doi: 10.1016/S2352-4642(19)30402-X
This week we speak with Professor of Surgery, Mark Rodefeld of Indiana University about the most recent report of his group on a sub pulmonary pump for Fontan patients. What is different about this pump versus other presently available pumps for other cardiovascular indications? What is known about the thrombogenicity of these devices? How close is the team in Indiana to animal studies? Why is a lower pressure type pump preferable for this indication? Dr. Rodefeld provides most of the answers this week. doi: 10.1016/j.jtcvs.2019.06.112.
We review a recent paper on the use of the AED for children who suffer out of hospital arrest. What factors are associated with their use and what barriers exist to their use for children? What should be the next steps to improve AED usage for children? We discuss these and other questions with Professor Peter Aziz of the Cleveland Clinic in our first co-branded episodes with the SADs Foundation in 2020! doi: 10.1542/peds.2017-1903
This week we review a recent large single center study comparing pulmonary homografts to bioprosthetic valves in the TOF patient requiring valve replacement. Is there a superior choice? Who is a better candidate for one versus the other? Which is technically easier to use and why? Who would benefit from an aortic vs. pulmonary homograft in this pulmonary position? We speak with Professor Massimo Caputo of the Bristol Heart Institute who answers these and other questions related to this important surgical paper this week. doi: 10.1161/JAHA.119.013654
Alin Gragossian, DO has an unusual perspective in medicine - she is an emergency room physician but also a cardiac transplant recipient. In this milestone 100th episode Dr. Gragossian shares her experiences of learning that she had dilated cardiomyopathy just one year ago, getting admitted to the ICU, and undergoing a heart transplant - all in < 6 months. She is 'back on the job' and she shares the details of her trials and tribulations, inspiring us all with her courage and insights into the patient experience, from the doctor's viewpoint. A different kind of inspirational, portrait in courage episode for our 100th episode! Happy New Year to all!
This week we review a recent report on the benefit of 3D imaging and printing in preparing for ductal stenting. This intervention is complex and is fraught with risk. The team at Duke review their experience with the use of 3D modeling prior to intervention and what impact this has on outcomes. We speak with the first author, Dr. Reid Chamberlain, research fellow at Duke University Pediatric Cardiology about this recent publication. doi: 10.1002/ccd.28669
This week we review the results of one of the rare placebo controlled double blind trials of an agent in pediatric cardiovascular medicine - specifically, the Fontan Undenafil trial assessing the impact of this agent on parameters of exercise in the single ventricle patient. What measures of exercise were most affected by this agent and why? What side effects were encountered? Who should receive these agents? These are amongst the many questions we tackle with the first author, Dr. David Goldberg of The Children's Hospital of Philadelphia. doi: 10.1161/CIRCULATIONAHA.119.044352
Cardiogenetics is the topic this week as we review a relatively recent report on the topic of LV non-compaction. How often do patients with this finding have positive genetic findings? Who deserves genetic testing with this finding? Should all such patients be seen by a geneticist? How frequently should phenotype positive, genotype negative patients 'check in' with a geneticist? These are amongst the questions we review with famed cardiogeneticist and senior author, Professor Stephanie Ware of Indiana University. doi: 10.1161/CIRCGENETICS.117.001735
This week we review a recent report of the PC4 group assessing the impact of inter hospital open communication and collaboration on surgical outcomes. In what manner did participation in this collaborative CICU registry improve outcomes for different hospital surgical outcomes? Why was the improvement not homogeneous between centers? How long did it take for the impact of collaboration to positively improve outcomes? We discuss these and other questions with first author Dr. Michael Gaies, Associate Professor of Pediatrics - University of Michigan. doi: 10.1016/j.jacc.2019.09.04
This week the topic is cardiovascular surgery and we speak with Dr. Ignacio Berra of Buenos Aires Argentina about a recent work he co-authored with the surgical bioengineering team at Boston Children's Hospital regarding a newly developed tool to assess the aortic valve. Can this device safely allow for visualization of the valve under the usual aortic diastolic pressures to aid in anatomical assessment and post-repair assessment? What are the technical hurdles of using this device? Is it ready for use in humans? We discuss these and other questions with Dr. Berra this week. doi: 10.1016/j.jtcvs.2018.07.113
This week we review a work that aimed to improve the thoughtfulness of echocardiography usage in the postoperative period after congenital heart surgery. Dr. Kelly Cox and colleagues report on the use of a 'checklist' type 'pause' aimed at making certain that the ordering team in the CVICU are making an informed decision regarding the need for a new echocardiogram. How often should postoperative studies be performed? How often did the 'fluid check' actually show fluid? These are amongst the many questions we post to Professor Cox who presently works at Lurie Children's Hospital - Northwestern University. doi: 10.1111/echo.1450
ECMO use in the pediatric cardiac patient can be lifesaving but the long term effects are still not well known. This week we explore the neurodevelopmental outcomes in a cohort of patients from Boston Children's Hospital who underwent ECMO support following cardiac surgery and explore factors associated with their neurodevelopmental outcomes. How do these patients fare in comparison to non-ECMO pediatric cardiac surgical patients? Are there modifiable factors that may improve outcomes? We explore these issues with Dr. Ravi Thiagarajan, Professor of Pediatrics - Harvard University and Director of Cardiac Critical Care at Boston Children's Hospital this week. doi: 10.1007/s00246-019-02115-1
This week we speak with cardiovascular surgeon Dr. Johann Brink about a recent work he co-authored from the Royal Children's Hospital in Melbourne, Australia about the team's experience with shunt malfunctions. Are there factors that are associated with shunt failure in this sometimes fragile patient group? Survival to Fontan in most series is roughly 70% - what, if anything, can 'move the needle' to higher levels of survival in this patient population? Dr. Brink offers some interesting and important insights this week. doi: 10.1016/j.jtcvs.2019.03.126.
This week's episode is co-branded with the SADS Foundation and we review a recent work by the team at U. of Washington on a comparison between the ECG and the AHA 14 point evaluation recommendation for the identification of cardiac diseases that may predispose to sudden death amongst high school athletes. We speak with Dr. Jonathan Drezner of U. of Washington about this important work and he offers many insights into the pluses and minuses of both the history and physical approach as well as the ECG. Referenced in the podcast also is https://uwsportscardiology.org/e-academy/.
doi: 10.1161/JAHA.119.012235
This week we review a recent report from the CTOTC-04 study group assessing the impact of novel anti-rejection approaches which generally markedly reduce or remove steroids in the prevention of rejection. How are rejection rates affected by such an approach? Did incidences of diabetes or PTLD differ when using this form of steroid reduced approach in the 'low immunological risk' subset of patients undergoing heart transplantation? We speak with the first author of this work, Professor of Pediatrics, Dr. Jacqueline Lamour of The Albert Einstein College of Medicine. Dr. Lamour provides deep insights this week! doi: 10.1016/j.healun.2019.06.006
Identification of the tetralogy of Fallot patient at risk for ventricular arrhythmias might be the 'holy grail' of ACHD and still today the best predictors are unclear. This week we review a novel approach to this problem - the development of personalized computational models to effectively perform 'virtual EP studies' and predict reentrant ventricular arrhythmia risk in repaired TOF patients. We speak with Dr. Mark Cartoski, Assistant Professor of Pediatrics at Nemours duPont Children's Hospital about a recent work he co-authored on this topic. Can VT be predicted on a computer rather than with catheters in the heart?
doi: 10.1016/j.hrthm.2019.10.002
This week we review a recent work from the team at Children's National in DC and the NIH on the use of 3D fusion of MRI images with fluoroscopy to help inform interventional procedures. Does this form of "XFM" fusion improve outcomes and reduce radiation or contrast usage? Are there procedures in which this form of imaging might be best applied? We review these and other questions with the first author of this work, Dr. Elena Amin of UCSF. doi: 10.1002/ccd.28324
This week we review a recent small work on the impact of fetal diagnosis of congenital heart disease on the psychological well being of families. Does the fetal prenatal diagnosis and counseling result in less stress in comparison to the families of those diagnosed in the postnatal period? We review this and other questions regarding prenatal counseling with Dr. Miwa Geiger - Director of Fetal Cardiology at Mount Sinai Kravis Children's Hospital and Ms. Michele Cafone, MSN, RN, CPNP - Clinical Nurse Coordinator of The Fetal Heart Program at Sinai. Two top experts on counseling to address some important and provocative questions. doi: 10.1017/S1047951119001781
This week we explore an important paper from CHOP on the optimal approach to repair for Tetralogy of Fallot (TOF). Is there a benefit to a staged approach versus primary complete repair? Are there factors that might influence this decision of approach? We speak with Assistant Professor of Pediatrics Dr. Laura Mercer Rosa of The University of Pennsylvania about her recent large PHIS database study. doi: 10.1016/j.jacc.2019.05.057.
This week we celebrate Children's Cardiomyopathy Awareness Month by reviewing a recent work from PACES on the impact of obesity on ventricular thickness in hypertrophic cardiomyopathy. Does obesity enhance thickness of HCM patients similarly to those without HCM? How does obesity affect risk for SCD in this condition? We review these and other questions with Dr. Seshadri Balaji, Professor of Pediatrics at OHSU. We speak also with Ms. Lisa Yue of the Children's Cardiomyopathy Foundation. What have been the foundation's greatest achievements? What are its present goals? Ms. Yue shares with us the inspiring story of how she and her husband started this important organization supporting pediatric cardiomyopathy research throughout the US. doi: 10.1007/s00246-019-02145-9
This week we review the impact of conduit size on exercise capacity in the single ventricle Fontan patient. Is there an optimal sized conduit for the Fontan patient? What is the role of formal exercise stress testing in the evaluation and monitoring of the Fontan patient? We review these questions and more with Associate Professor of Medicine at UT Southwestern - Dr. Ari Cedars. doi: 10.1007/s00246-019-02190-4
This week's episode is co-branded with SADS.ORG and we review a paper on the clinical presentation of those who have conditions associated with sudden cardiac death. Are there questions about the patient and family history and physical examination signs that can improve the identification of those at risk before an event of cardiac arrest? We review this important question and others with Assistant Professor of Pediatrics at Washington University in St. Louis, Dr. Aarti Dalal. Referenced also in this discussion is the following webpage: https://www.sads.org/Library/School-Materials/Risk-Assessment#.XW25gy2ZOu4.
DOI:10.1016/j.jpeds.2016.06.088
This week we discuss the results of a phase 2 trial of autologous stem cell therapy for the treatment of patients with HLHS. How challenging was it to obtain autologous stem cells from a large number of patients in multiple locations throughout North America? What are the theoretical benefits for this form of therapy? What evidence presently exists for its potential efficacy? How is this therapy best delivered to the myocardium. We discuss these and other questions with the senior author of a recent work on this topic, Professor Timothy Nelson of the Mayo Clinic. doi: 10.1016/j.jtcvs.2019.06.001
This week we enter the worlds of fellow education and echocardiography to review a recent report of a QI project performed at Children's Hospital of Philadelphia regarding the performance of echocardiograms by first year fellows in cardiology. Can the implementation of a checklist protocol improve the consistency of echocardiograms performed by fellows? What was the impact of this protocol? What areas were particularly well served by this approach? Dr. Brian White, senior cardiology fellow at CHOP provides important insights into this project that he co-authored. doi: 10.1111/echo.14441
This week we review a recent study from The University of Toronto on the impact of timing of the arterial switch operation for DTGA on brain growth and neurodevelopmental outcomes. Can the timing of this surgery impact these outcomes? What is the reason for this? Is it rational to perform this surgery early to improve neurological outcomes? How important is the conduct in the OR versus the ICU? These are amongst the questions we address with Professor Jane Newburger of Harvard University - Boston Children's Hospital this week! doi: 10.1161/CIRCULATIONAHA.118.037495
This week we review a recent paper on the topic of durable VAD's in congenital heart patients. Who is a candidate for such a device and what are the outcomes with these in this selected patient group? What are the impediments to their use? What role might public reporting have on the use of these devices and transplantation in general on the congenital heart population? We touch on all of these questions and more with Dr. Lauren Glass, Assistant Professor of Pediatrics at The Icahn School of Medicine at Mount Sinai - NYC where she is Associate Director of Heart Failure and Cardiac Transplantation. doi: 10.1097/MAT.0000000000001041
This week's episode is our second 'co-branded' episode with the SADS Foundation (SADS.ORG) and we speak with the founder and director of Crediblemeds.org, Professor of Medicine Ray Woosley of the University of Arizona. Dr. Woosley speaks with us about how he started the first website dedicated to assessing the evidence for drugs' impact on the QT interval establishing a reliable and trusted website for clinicians and patients to visit to learn about possible drug interactions and their impact on LQTS and the QT interval in general. How was the site first conceived? What are the latest changes on the site? What are the plans for this work going forward? Is grapefruit juice really dangerous? Why does the site request that all have to sign up to access the site? Professor Woosley provides all the answers and more this week!
This week we review a recent Swedish paper that assessed the risk for cancer in patients with congenital heart disease and compared this to normal controls in a large administrative database. Why are cancer rates different in the congenital heart patient? What are the most important factors? What actions should be taken by those cardiologists caring for ACHD patients to properly screen for cancer? We discuss all of the above and more with Assistant Professor of Pediatrics - Harvard University - Dr. Michelle Gurvitz. doi: 10.1001/jamanetworkopen.2019.6762
This week we explore a provocative paper on the use of a femoral vein homograft for Sano shunt for Stage I palliation for HLHS. Does the incorporation of this form of shunt improve outcomes? How does the valve in this graft function over time? Are there demonstrable improvements in RV function or PA growth when using this approach? We speak with Dr. TK Susheel Kumar who is Associate Professor of Surgery at NYU Medical Center. Dr. Kumar shares his thoughts and insights into this novel approach. https://doi.org/10.1016/j.jtcvs.2019.03.123
This week we have a replay of an episode from 9 months ago on T wave inversions in athletes and why their presence may represent possible disease in the athlete. We speak with Professor Sanjay Sharma of the UK who is a world authority on this topic. This is an important episode worth hearing once more. Coming this week in the middle of the week is our 75th episode with Professor Sylvia Griffiths! Keep a look out for Professor Griffith's episode coming later this week!
This week we review the topic of transposition of the great arteries and the most common late long term complication of the arterial switch operation - supravalvar pulmonary distortion or stenosis. How effective were interventions for this problem and what complications were encountered? Does balloon dilation alone ever work to help this problem? Are there risk factors for possible catheterization related complications when working on the pulmonary arteries? We discuss these and more questions with the first author of a recent report on this topic - Dr Jesse Lee who is Assistant Professor of Pediatrics at Baylor College of Medicine. Dr. Lee reviews this large series from his former group at Rady Children's Hospital. doi: 10.1111/chd.12726
This week we jump back into the world of ACHD and review a recent registry study assessing outcomes in adults with ASD and elevated PVR who underwent ASD closure. Who was a good candidate for this approach? What were the long term outcomes of this form of therapy? Did ASD closure in this setting confer a survival benefit? We review these and many other questions in a 'virtual roundtable' discussion with Drs. Elisa Bradley of Ohio State and Ali Zaidi of Mount Sinai - NYC. Both are world authorities on ACHD and it is a great treat to have such 2 experts both on the show to discuss the subtleties of this complex topic. doi: 10.1016/j.ijcard.2019.03.056
This week we enter the worlds of cardiovascular surgery and interventional catheterization to review a recent STS dataset analysis of postoperative transcatheter interventions. Who needed these sorts of catheterizations more commonly after surgery and what was the relation between needing such an intervention and overall outcomes? How much variability existed between centers in their use of interventional cath following congenital heart surgery? We speak with Associate Professor of Pediatrics, Kevin Hill of Duke University about his recent study on this subject. doi: 10.1161/CIRCINTERVENTIONS.119.007853
In this special episode # 71 co-presented with the SADS Foundation (SADS.ORG) we speak with the president of the foundation, Professor Michael Ackerman of The Mayo Clinic about a recent work he co-authored on a novel approach to assessing patients with possible CPVT. How should the phenotype help to inform genotype results? Can a novel CPVT scorecard help to improve our understanding of genetic test results? How are genes determined to be 'benign', 'likely disease causing' or a variant of uncertain significance (VUS)? We discuss these issues and more with Dr. Ackerman who provides great insights into this fascinating topic that affects all cardiologists who use genetic testing as part of their practice. doi: 10.1161/CIRCGEN.119.002510
This week we review the role that complications have on outcomes in the ACHD patient undergoing cardiac surgery. How commonly do complications occur and if they do occur, what impact do these have on ultimate outcomes? Are there strategies that can be employed to reduce complications amongst this fragile patient population? We discuss these issues and more with the senior author of this work, Dr. Oscar Benavidez who is the Director of Congenital Cardiology at Massachusetts General Hospital in Boston, MA. doi: 10.1007/s00246-019-02103-5.
This week we speak with Professor Yoav Dori of Children's Hospital of Philadelphia about a recent paper he co-authored on the topic of lymphatic abnormalities in children with Noonan's syndrome. What are the typical findings in severely affected children and who is a candidate for intervention? Are there patients who are good candidates for 'thoracic duct ligation' or pleurodesis? Is there anyone in whom this would be considered appropriate therapy? We discuss these questions and more with the master of the lymphatic system, Dr. Dori. doi: 10.1007/s00247-018-04337-6.
This week we explore a recent CMR study in Fontan patients assessing the impact of pulmonary blood flow maldistribution and exercise capacity. How closely associated are these differences in relative pulmonary blood flow to functional status and overall outcomes? How aggressively should we intervene for these sorts of problems? We discuss these issues and more with Dr. Rahul Rathod who is the senior author of this work and also Assistant Professor of Pediatrics, Harvard Medical School. doi: 10.1186/s12968-018-0505-4
This week we review a fascinating paper that assesses the direct myocardial effects of IV antiarrhythmic agents upon cardiac muscle function performed by the group at Boston Children's Hospital - Harvard University. We speak with one of the principle authors of this work, Dr. Elizabeth DeWitt, who is an attending electrophysiologist at that large institution about this important work. Which agents were substantial negative inotropes and which had no effects? The answers may be surprising. Dr. DeWitt shares the general approach of the team in Boston when treating arrhythmias that require rapid IV therapies. doi: 10.1177/1074248418810811
This week we review a critically important neurodevelopmental issue affecting infants who have single ventricle palliation - namely hearing loss. How common is hearing loss seen and what role does IV furosemide play in this finding amongst single ventricle patients? Are there techniques to avoid this complication and yet still use this commonly used diuretic agent? We discuss this important issue and study with Dr. Ari Joffe, Professor of Pediatrics University of Alberta - Stollery Children's Hospital who is the senior author of this week's work. doi: 10.1097/PCC.0000000000001807
This week it's National Pediatric Transplant Week and we review a recent work on ECMO following cardiac transplant and speak with its first author, Assistant Professor of Pediatrics in Vanderbilt University, Dr. Justin Godown. How does the use of ECMO in the postoperative period influence outcomes in the short and long term? Are there differences in outcomes when it is used for patients with cardiomyopathy versus congenital heart disease? We review all of these and more with Dr. Godown. We speak also with Melissa McQueen of Transplantfamilies.org about her organization which strives to educate and support the families of children undergoing transplantation. Ms. McQueen's story is certainly an inspiring one. doi: 10.1111/petr.1341
This week we review a recent report from Duke University regarding the incidence of femoral arterial thrombosis after femoral arterial cardiac catheterization in small infants. How did the use of routine ultrasonography improve identification of this post-cath complication? What are the outcomes of therapy with heparin or enoxaparin for this problem? Are there factors that are associated with femoral arterial thrombosis? We discuss these questions and more with Associate Professor of Pediatrics, Kevin Hill. doi: 10.1002/ccd.28009
This week we explore the utility of exercise stress echocardiography in pediatric patients. How often were clinical decisions made based upon findings at stress echo? What sort of extra training is needed to perform these studies? How safe was this form of testing? How are stress echo results incorporated into the decision making process for pediatric patients at Emory University? Dr. Soham Dasgupta, 2nd year fellow in cardiology and first author of this work, shares some of the insights of this large Emory experience. doi: 10.1111/echo.14326
This week we review 2 surgical reports. The first is on the Ozaki Procedure for aortic valve repair and we speak with valvular expert David Kalfa, MD PhD of Columbia University. Who is a good candidate for this approach and what evidence exists of its efficacy in children? Dr. Kalfa shares his insights. We also review a recent report from Taormina, Italy on outcomes of repair of anomalous origin of the PA's from the ascending aorta. We discuss this work with its author, Professor Salvatore Agati. doi: 10.1016/j.jtcvs.2018.01.087
This week we review a recent randomized and controlled trial from the NEJM on the use of the novel Medtronic TYRX envelope for the prevention of pacemaker or ICD infections in adult high risk patients. Did the use of this antibiotic envelope result in reduced incidences of infection? Were there complications associated with its use? Should this be used in only in high risk patients? Is this a cost effective solution? These are amongst the many questions we tackle with co-author of this important trial, Dr. Suneet Mittal who is the Director of Cardiovascular Research at Valley Hospital in Ridgewood, NJ. Dr. Mittal offers great insights into this trial and possible implications of these important findings. DOI: 10.1056/NEJMoa1901111
This week we review a recent report from the team at the Kravis Children's Hospital at Mount Sinai - Icahn School of Medicine at Mount Sinai on the use of pentobarbital for oral sedation for transthoracic echocardiography. Associate Professor of Pediatrics Rajesh Shenoy shares with us insights into sedation for this indication, the general approach of the echo lab at Sinai and how decisions are made regarding sedation for this reason. doi: 10.1111/echo.14301
This week we review a recent report on transcatheter pulmonary valve replacement with the Sapien S3 prosthesis. What are the circumstances in which this valve might be preferable versus other valve types? What are the disadvantages of this device? How can patients be effectively screened as candidates for different valves? How can decisions be made between self expanding systems like Harmony or Venus P versus this sort of device for large RVOT's? We review all of these issues and more with Dr. Daniel Levi of UCLA who offers a wonderful overview of transcatheter PVR in 2019. You will not want to miss his many insights. doi: 10.1002/ccd.27973
This week we review an impressive review of the large Australian/New Zealand registry of Fontan patients assessing the impact of AV valve regurgitation and failure on Fontan outcomes. We discuss this work with the senior author Yves D'udekem, Associate Professor of Surgery at The Murdoch Children's Research Institute and also speak with Professor Frank Cetta of the Mayo Clinic who authored a wonderful editorial on this work. Who is at most risk for AV valve failure at Fontan? How well do patients do with AV valve replacement or repair? We discuss all these issues this week on this exciting episode. doi: 10.1016/j.jacc.2018.12.025
This week we review a recent publication on modern day outcomes for children with dilated cardiomyopathy. It seems as if they are doing better than patients did 10 years earlier - why is this so? What factors may account for the improvements in outcomes? We discuss these questions and more with the first author of this multi center work, Dr. Rakesh Singh, Associate Professor of Pediatrics at UC SanDiego and also the Director of the Pediatric Heart Failure and Transplantation Program at Rady Children's Hospital. doi: 10.1016/j.jacc.2017.09.1089
This week we discuss the rationale for intervening for unilateral proximal PA stenosis with a stent or angioplasty. In the setting of normal RV function or pressure, are there exercise data to support intervening and if so, at what degree of maldistribution should such an intervention be considered? How should this decision be made? Is this safe? We review these and other questions with the first author of this work, Gurumurthy Hiremath MD who is the director of the pediatric catheterization laboratory at the University of Minnesota. doi: 10.1016/j.jcin.2018.11.042
This week we review a recent paper on the topic of extended ambulatory ECG monitoring in the ACHD patient. Does this form of monitoring provide benefit versus a more traditional 24 or 48 hour "Holter" monitor? How commonly were arrhythmias in ACHD patients found after 48 hours and how commonly were changes made to management based upon these findings? We discuss these issues and more with the senior author of this work, Dr. Scott R. Ceresnak, Associate Professor of Pediatrics - Stanford University. doi: 10.1111/chd.12736
This week we review the topic of pulmonary hypertension and specifically the use of sildenafil for treatment of this difficult problem. Is this agent safe in children? How commonly does it need to be discontinued for side effects? Is it effective? Do patients ever improve to a degree that it can be discontinued? We review all of these questions and more with Dr. Jennifer Cohen who wrote this work while a general cardiology fellow at Columbia University but is now the Advanced Non-Invasive Imaging Fellow at The Icahn School of Medicine at Mount Sinai - NYC. doi: 10.1016/j.jpeds.2018.09.067
This week we speak with Associate Professor of Medical Psychology at UNSW, Nadine Kasparian about a recent publication regarding evidence for efficacy for various forms of psychological therapy in the setting of childhood-onset heart disease. What do we know about the efficacy of interventions for this fragile population of congenital heart disease patients? How prevalent are psychological problems amongst patients and patient families with childhood onset heart disease? What approaches work best? Dr. Kasparian points to the future in regards to what is needed going forward to advance our knowledge of this critically important problem affecting pediatric and adult congenital heart disease patients. doi: 10.1037/hea0000704
This week we go back to the world of artificial intelligence and review a recent work from Stanford University on the use of deep neural networks to interpret ECG rhythms. How good did a novel algorithm do in comparison to cardiologists in characterization of rhythm abnormalities? What are some novel uses of AI in medicine today and how can AI potentially identify signs of disease that even human scientists are unable to discern? We discuss these interesting questions and many others with Pranav Rajpurkar who is a PhD candidate in computer science at Stanford University and a co-author of this week's important work that we review. doi: 10.1038/s41591-018-0268-3.
This week we delve into the world of fetal cardiology to review a recent work comparing fetal MRI to fetal echo. How did this relatively new technology application fair in comparison to more traditional echocardiography? What role might this technology have in the assessment of congenital heart disease in the fetus? We explore these questions and others with fetal cardiology expert, Professor Lisa Hornberger of the University of Alberta - Stollery Children's Hospital. Dr. Hornberger also discusses how she personally uses CMR in her own fetal practice. doi: 10.1161/CIRCIMAGING.118.007745
This week we review a recent work on contrast induced acute kidney injury in the ACHD patient undergoing catheterization. Are there data to suggest what a safe volume of dye might be in this population of patients? Does the renal response to contrast suggest something about the general health of the patient? How does the team in Boston plan catheterizations in the adult congenital population to minimize contrast usage? We review these questions and others with the first author of this work, Dr. Laura Gellis, who is a senior clinical fellow in cardiology in the Department of Cardiology, Boston Children's Hospital - Harvard Medical School. doi: 10.1002/ccd.27798.
This week we review the Fontan and long term issues of surveillance and Fontan failure with 2 articles. The first is a large survey study reviewing practice patterns amongst large Fontan clinics in the US. We review this interesting topic of optimal assessment of the Fontan with Dr. Mike DiMaria who is first author of this recent work and also Associate Professor University of Colorado. We then review a case report on biphasic curaiss ventilation for the treatment of Fontan associated PLE and plastic bronchitis with first author Professor Seigo Okada from Kyushu Hospital in Japan and also with Dr. Pradeep Charla who is the director of the adult congenital heart program at University Hospitals and Rainbow Babies Hospital. Both Dr. Okada and Dr. Charla have extensive experience with this form of 'iron lung' therapy in the setting of a Fontan and share this experience with us all. doi: 10.1007/s00246-018-1966-9 and doi: 10.1536/ihj.17-292.
This week we turn to the world of cardiovascular nursing and review the notion of individualized family centered care for infants in the CICU. What is meant by the term "Individualized Family-Centered Developmental Care" and what are its components? What is the evidence that use of this approach can result in improved neuro-developmental outcomes? We review these important concepts with the first author of this work, Amy Jo Lisanti PhD, RN who is a clinical nursing specialist and researcher at The Children's Hospital of Philadelphia. Dr. Lisanti explains this novel multidisciplinary approach to care in the CICU and why she believes it may hold hope in improving outcomes following complex neonatal surgery. doi: 10.1097/JCN.0000000000000546
This week we review the notion of sports participation in athletes who have ICD's. Is this a safe approach? How do the athletes fare? How do the devices stand up to sport? What are the subtleties of discussing this important topic with a family and how does shared decision making work in this process? We review this serious and complex topic with Dr. Rachel Lampert, Professor of Medicine at Yale University and Dr. Elizabeth Saarel, Professor of Pediatrics - The Cleveland Clinic. Both experts have much to share about their experience in this important work on how to potentially improve the quality of life for our ICD patients. doi: 10.1161/CIRCEP.118.006305
This week we enter into the world of cardiac morphology and speak with Professor Leo Lopez of Stanford University about a recent work he wrote with the International Society for Nomenclature of Pediatric and Congenital Heart Disease regarding proper nomenclature for VSD's. Is it defect geography or borders that are most important in naming these structures? How was agreement forged between such disparate super-hero experts in cardiovascular medicine and congenital heart disease? Is Dr. Lopez using these designations at the present time? What's next for the nomenclature group? Dr. Lopez shares his insights this week and, as a special treat, also sings as the musical coda to today's program. A very special treat indeed! doi: 10.1016/j.athoracsur.2018.06.020
This week we review a landmark paper reviewing the very large experience of Dr. Hanley and his team at Stanford University in managing VSD/PA with MAPCA's. What advantages are seen with the 'midline unifocalization' approach popularized by this team over the past 20+ years? Is this an approach that can be broadly applied or are the technical operative skills too challenging for most? Why are these operations so difficult? How does the Stanford team decide who is a candidate for a single operation and who is not? We explore many of these topics and others with Surgery Professor Richard Mainwaring of Stanford University who is the first author of this important paper published recently in JTCVS. You will not want to miss Dr. Mainwaring's insightful commentary on the challenges and potential benefits of this very complex and painstaking approach. doi: 10.1016/j.jtcvs.2018.03.153.
This week we return to the world of adult congenital heart disease to review 2 related works on the topic of late cardiovascular risks in patients who have undergone prior coarctation repair. Are such patients at elevated risk for early coronary artery disease and stroke? What are the causes for these late complications? What role does hypertension play in the development of these late sequelae? Are there other factors that may explain these risks and how should patients be screened for these issues? These are amongst the questions we review with Dr. Sarah Pickard, Instructor in Pediatrics, Harvard Medical School and first author of 2 important new works from the team at Boston Children's Hospital and Brigham and Women's Hospital. doi: 10.1016/j.amjcard.2018.08.051 and doi: 10.1161/JAHA.118.009072
This week we explore the topics of cardiomyopathy, electrophysiology and sudden death and delve into the world of arrhythmogenic right ventricular cardiomyopathy (ARVC). What role might autoimmune disease play in this disorder? Can a biomarker potentially allow us to identify the vast majority of individuals with this disease with high sensitivity and specificity? Can this biomarker identify 'pre-clinical' disease? Can immunological therapies possibly be used to change the course of this disorder? We explore all of these issues and more with Professor Robert Hamilton, University of Toronto, this week on the podcast. This is groundbreaking research that represents a paradigm shift in our understanding of this potentially lethal disorder. doi: 10.1093/eurheartj/ehy567
This week we review a recent paper from Circulation on the topic of preoperative factors that may impact outcomes of the arterial switch operation. Is there an optimal time to perform an arterial switch operation? Are there other modifiable factors that may auger a better outcome with shorter hospital stay and lower cost? We discuss these questions and others with the first author of this work, Assistant Professor of Pediatrics at The Perelman School of Medicine, University of Pennsylvania, Dr. Michael O'Byrne. Circulation. 2018;138:2119–2129.
This week we enter the world of fetal cardiology to ask the question, 'Can an inexpensive heart rate monitor for fetuses accurately identify in a timely manner fetal patients with impending heart block and can this allow for more timely and potentially effective therapies for AV conduction disease associated with maternal antibodies?' Is there an optimal time to intercede? We discuss a recent multi center work on a home monitoring program with its first author and world authority on fetal cardiology, Professor Bettina Cuneo of the University of Colorado. This is another possible 'game changer' article. doi: 10.1016/j.jacc.2018.07.076
This week we review a paper from the Amrita Institute in Kerala, India on outcomes of infant surgery in that region and discuss the results with its senior author, Dr. Raman Krishna Kumar. Professor Kumar explains how this large center in India has been able to develop a program that would be the envy of any city in the world, all on a 'shoestring' budget. He reviews with us the path he took from the time he left the US with cardiology training and how he and his associates were able to build one of the finest cardiovascular centers for children in the world. This is a fascinating and inspiring discussion with one of finest cardiologists and human beings in our field. Dr. Kumar's stirring accomplishments for the children of India are noteworthy and his discussion is one of the true highlights of this podcast thus far. For donations to Dr. Kumar's center, please reach out to him at kumar_rk@yahoo.com. doi: 10.1053/j.semtcvs.2015.09.008.
This week we speak with Dr. Douglas Mah, Assistant Professor of Pediatrics - Harvard Medical School and Director of the Pacemaker and ICD Service at Children's Hospital Boston about a recent paper he published with his colleagues on coronary artery compression from epicardial pacemaker leads. Who is at risk for this rare complication? How can patients be screened? Once identified, what is the treatment? We review all this and more with Dr. Mah. doi: 10.1016/j.hrthm.2018.06.038
This week we explore the world of 'fast tracking' patients following cardiac surgery and focus on how to best provide analgesia and sedation to such patients. Are there advantages to intermittent boluses of such agents rather than a low dose basal infusion? What are the implications of such a strategy for nursing and medical care? Does 'waiting' for discomfort prior to administration of medication work better than 'preventing' such? Are there patients who would not be good candidates for such an approach? We explore these issues with Assistant Professor of Pediatrics at Mount Sinai Medical Center - NYC, Dr. Scott Aydin who is also associate director of the pediatric critical care unit at that same institution.
This week we explore the question of optimal timing of the Fontan operation. What factors are associated with good or bad outcome after Fontan in regards to age at surgery? Can Fontan palliation have a positive impact on cardiac function? Is there a 'sweet spot' regarding timing of this single ventricle palliation? Who deserves a fenestration? These are amongst the many questions we review this week in our review of a recent large German experience in Fontan in patients with advanced age at Fontan. We discuss the paper and aspects of it with noted surgeon Dr. Ram Kumar Subramanyan, Assistant Professor of Surgery and Pediatrics of USC - Children's LA. DOI: 10.1016/j.jtcvs.2018.03.155
Interventional cardiology is on tap this week as we explore the world of transcatheter management of the dysfunctional RVOT with 2 papers on this topic. In the first, Dr. Mary Hunt Martin, Assistant Professor of Pediatrics - University of Utah is the first author on a recent PHN paper on outcomes of Melody implantation in the native RVOT. Dr. Martin joins us to answer a number of questions about this important work. The second work is a recent multi center French study on use of the Sapien valve in the RVOT/conduit. How do the acute results with this valve compare with the Melody? What are the indications for Melody vs. Sapien? These are amongst the questions we tackle this week on the podcast. DOI: 10.1016/j.jcin.2018.05.051 and DOI: 10.1016/j.jcin.2018.05.050
This week we explore the interpretation of T wave inversions in the athlete with Professor Sanjay Sharma, Professor of Cardiology University of London. Which T wave inversions are "normal variants" and which are worrisome for disease? What is the role of genetic testing in determining who has disease? We review Prof. Sharma's group's recent paper on this topic and discuss different aspects of this work with this world-renowned figure in this field. DOI: 10.1161/CIRCULATIONAHA.118.034208
This week we delve into the world of Marfan Syndrome and review a recent report from the Pediatric Heart Network with the first author of this work, Dr. Seda Selamet Tierney - Associate Professor of Pediatrics, Stanford University. Why does stiffness of the aortic wall predict dilation and need for surgery? Does the use of atenolol or losartan affect aortic growth or dilation? Which agent is preferable? Dr. Selamet Tierney shares her insights this week on the podcast. DOI: 10.1016/j.amjcard.2018.01.016
This week we review a novel paper on MRI changes observed in TOF adults. Are these signs for advanced brain 'aging' in tetralogy adults? We also review a prospective trial of different mechanical ventilation strategies during SVT ablations in children. Can tidal volume or PEEP affect catheter stability while mapping or ablating SVT? We discuss this question with the first author of this work, Dr. Christopher Janson, Assistant Professor of Pediatrics at The Children's Hospital of Philadelphia. Articles: DOI: 10.1371/journal.pone.0202496; DOI: 10.1007/s00246-018-1968-7
This week we explore the world of cardiac transplantation with particular emphasis on the Fontan patient and transplantation. Outcomes are improving rapidly. Why is this? What about the liver and how are decisions made regarding cardiac versus cardiac+hepatic transplantation in this patient population? We review all of these questions with world authority on cardiac transplantation Dr. Daphne Hsu, Professor of Pediatrics, Chief of Pediatric Cardiology and Interim Chair of Pediatrics at Montefiore - Albert Einstein College of Medicine. Her insights into this complex patient group are valuable and novel. Article reviewed: DOI: 10.1016/j.athoracsur.2016.08.110
This week we explore both fetal cardiology and cardiovascular surgery. The first work reviews a fascinating case report of fetal treatment of cardiac rhabdomyomas in the setting of hydrops fetalis. The second reviews a recent report on LV retraining prior to attempted double-switch operations in LTGA and DTGA. Can one accurately predict 'retrainability' of the LV? Can life threatening rhabdomyomas be treated in fetal life? These are amongst the questions answered this week. Articles: DOI: 10.1056/NEJMc1800352; DOI: 10.1016/j.athoracsur.2017.11.047
This week we explore the notion of pulmonary valve function preservation at the time of TOF/PS repair with Dr. Ram Emani, Associate Professor of Surgery at Harvard Medical School/Boston Children's Hospital. Dr. Emani shares his insights from recent work he and colleagues have performed using a novel intraoperative balloon dilation approach. Can TOF/PS repair be performed without creating significant degrees of pulmonary valve regurgitation? We learn the answers this week.
This week we discuss 2 papers on different areas of congenital cardiology. The first is a recent Brazilian report on Zika Virus Syndrome and associations with congenital heart disease. The second is a recent report by the team at Children's Hospital of Philadelphia on exposure to plastic neurotoxicants found in many common medical devices. Do these plastic substances have an impact on neurodevelopmental outcomes? Dr. William Gaynor of CHOP speaks with us about this very important and somewhat troubling work.
This week we review a very recent work on long term (14 years!) outcomes of children with hypertrophic cardiomyopathy in Australia and speak with its author, Professor Robert Weintraub of Royal Children's Hospital in Melbourne. Dr. Weintraub explains the data in his work for us and what he considers to be important risk factors for poor outcomes. He also shares some thoughts on how he thinks about who might be a candidate for primary ICD prophylaxis in the young HCM population.
This week we explore 2 unrelated but possibly 'game changing' papers. First we delve into a very recent report on a novel intranasal therapy for acute termination of SVT. Then we review a recent report from the Boston Adult Congenital Heart Program (BACH) on a potential role for inflammation as a possible cause for poor outcomes in ACHD patients. Can inflammatory markers predict poor outcomes in ACHD patients as they do in non ACHD adult patients? Dr. Alexander Opotowsky, Associate Professor of Pediatrics at Harvard Medical School shares his insights into this very unusual and novel concept in the world of ACHD.
This week we delve into the world of novel means for epicardial pacing and defibrillation in small children or those with congenital heart disease. Dr. Bradley Clark of The Children's Hospital at Montefiore and Dr. Yaniv Bar-Cohen of Children's Hospital of LA discuss their recent works on developing minimally invasive epicardial pacing and defibrillation in infants and those with congenital heart disease. The ability to provide epicardial pacing or defibrillation without the need for a surgical incision is exciting and both experts speak of the challenges and future of this important work.
This week we replay the 2nd podcast in the series. Dr. George Ofori of Montefiore reviews a recent paper on a project in Angola to provide outstanding congenital cardiovascular care in that nation and the challenges associated with these sorts of projects and we also review an extraordinary report of non-invasive ablation of severe ventricular arrhythmias using radiation. Can arrhythmias be ablated successfully without even placing a catheter in the heart? This recent article from The New England Journal suggests that this may be an exciting paradigm shift in electrophysiology. We will be back with a new podcast next week!
In this landmark 25th episode of the podcast we delve into the world of echocardiography with one of the masters of this field, Dr. Shubhika Srivastava of Mt. Sinai Medical Center in NYC to discuss a recent paper by her team on 'twisting' and 'untwisting' abnormalities in repaired tetralogy patients. Who is at risk for these problems? What do these findings mean? Can they help inform decisions regarding surgery or follow-up? Dr. Srivastava helps us understand this somewhat complex topic on the podcast this week!
This week we explore the role of transcatheter closure of the PDA in the infant, particularly those < 2 kg and even < 1 kg. We review data from the IMPACT trial on closure of the PDA in small infants and also discuss an important paper by Dr. Evan Zahn on transcatheter closure of PDA's in the premature or very small infant. What are the outcomes when closing the PDA in a small infant? What are the possible benefits or risks? Dr. Zahn offers many answers and also gives us some insights into the near future of this rapidly developing approach to the transcatheter management of the large duct in a small child.
This week we review a recent paper on follow-up of the novel approach of percutaneous carotid artery vascular access in infants requiring neonatal or early infancy catheterizations with Dr. Christopher Petit of Children's Healthcare Atlanta - Emory University. Dr. Petit reviews how the team in Baylor and Atlanta came to use this type of vascular approach and also some important 'pearls' of performing these very difficult and dangerous procedures. What happened to the carotid arteries after Dr. Petit and colleagues placed vascular sheaths in them when they performed repeat angiography 3+ months later? Dr. Petit shares his experience with us all this week!
This week we explore fetal cardiology with 2 fetal cardiology experts - Mary Donofrio, MD from Children's National Medical Center and Maciej Slodki of Polish Memorial Mother's Research Institute. Both authors/experts discuss the notion of predicting the initial minutes and hours after birth with complex congenital heart disease. Are there new ways to predict the need for atrial septal intervention in HLHS or DTGA? Drs. Donofrio and Slodki help explain.
This week we delve into the world of postoperative CICU management of complex congenital heart surgical patients with one of the pioneers of this field, Dr. Anthony Rossi of Nicklaus Children's Hospital. Dr. Rossi has been at the forefront of research into the optimal management of children following complex congenital heart surgery. Are there ways to predict problems before they become problems in these ill infants? Dr. Rossi has 30 years of experience with this question and shares his insights and the evolution of his thoughts on this topic this week...
This week's 20th episode tackles the topic of pulmonary hypertension both in the newborn premature infant and the adult with primary pulmonary hypertension. We have 2 experts this week - Dr. Nicole Sutton of Albert Einstein College of Medicine and Erika Berman Rosenzweig of Columbia University College of Physicians and Surgeons speak about managing pulmonary hypertension in infants with BPD and history of prematurity and also the exciting novel approach of using a Pott's shunt to palliate primary pulmonary hypertension in the adult. You will not want to miss these expert's insights into their field.
This week we delve into the topic of pregnancy in the single ventricle Fontan patient with 2 experts in this area - Dr. Melinda Davis of University of Michigan and Dr. Mark Johnson of Imperial College - London, England - to discuss who is a good Fontan candidate for pregnancy and what are the risks. We review the latest data on this area and also the many aspects of this topic that remain unknown at this time.
In this week's episode we learn about the latest data on pulmonary vein stenosis outcomes from a large meta-analysis of prior works on this topic and then review recent provocative data from the group in Boston on the use of adjunctive biological inhibition agents in concert with interventional approaches to combat multi vessel intraluminal pulmonary vein stenosis. The work's first author, Dr. Ryan Callahan of Boston Children's Hospital joins us to review this important trial's results and to review aspects of how his team assesses and manages these complex and heterogeneous patients.
In this episode we review 2 wonderful recent works. The first reviews the use of perioperative EP studies to predict postoperative VT and SCD amongst TOF patients undergoing PVR. The second is an intriguing study on the relatively new concept of HIS BUNDLE pacing. Joining us this week is Dr. Edward Walsh from Boston Children's Hospital to discuss his thoughts on ventricular arrhythmias in the setting of TOF and their prevention. His insights are worth a listen!
This week we learn about the exciting field of 3D printing in congenital heart disease. We discuss an interesting article on this topic that was recently published with one of the true world authorities on this topic, Dr. Kanwal Farooqi who is Assistant Professor of Pediatrics at Columbia University. Dr. Farooqi will take us through the basics of this rapidly evolving field and explain to us how the technology may one day lead to printing biological 'spare parts' like patches, conduits or even valves for the heart. You won't want to miss this peephole into an exciting future with Dr. Farooqi.
This week we delve into the exciting world of congenital interventional cardiology with 2 very different types of interventional cardiology research. In the first highly technical work from the group at Children's Hospital of Michigan in Detroit, we review an innovative approach to transcatheter management of pulmonary regurgitation in tetralogy when the RVOT is just too large for a valved stent. Dr. Tom Forbes, director of the cardiac catheterization laboratory and co-author of this work, discusses the challenges to and indications for bilateral branch pulmonary artery valve implantation in such cases. In the second work, the concept of practice variation and its impact on outcomes is explored by Dr. Andy Glatz and the team from Children's Hospital of Philadelphia reporting data from the IMPACT registry on compliance of interventionalists with established and published guidelines for proceeding with aortic or pulmonary valvuloplasty. Dr. Glatz will join us to discuss some of the interesting aspects of his work as well as trying to answer the question of whether 'homogenizing' our approach to a somewhat 'heterogeneous' group of patients makes good sense.
This week we review 2 works on the topic of aortic coarctation. The first reviews outcomes of arch repair in the setting of a bovine arch and the second reviews the possible long term impact of having mild transverse arch hypoplasia after repair - a common problem afflicting many patients who have undergone coarctation repairs. Dr. Emile Bacha, Professor of Surgery at Columbia University and Dr. Ashwin Prakash, Associate Professor of Pediatrics and Director of the Cardiac MRI Service at Harvard University will speak to us directly about these papers and their thoughts on this important topic. Should coarctations be approached from the front or the side? Drs. Bacha and Prakash will offer us some answers.
This week we review 2 works on pediatric ventricular assist devices and the most common adverse event associated with their use - specifically, infections. Dr. Scott Auerbach, medical director of the ventricular assist device program at Denver Children's Hospital and Associate Professor of Pediatrics at The University of Colorado will discuss the findings of the PEDIMACS registry data as well as share some new, hot off the presses information regarding outcomes of pediatric patients with infections who then undergo transplantation. His insights into this data set are deep and we are lucky to have him speak about this important multicenter work.
This week we explore the topic of Artificial Intelligence with a true expert in the field, Dr. Anthony Chang who is chief intelligence and innovation officer at Children's Hospital of Orange County. Dr. Chang recently earned a master’s degree in Biomedical Data Science and Artificial Intelligence from Stanford University and he reviews with us what AI is, what the potential value of this technology might be for medicine and discusses the obstacles that exist for full implementation and development for medical applications. Should we embrace or be fearful of this future? Dr. Chang will provide the answers….
This week’s episode explores the sedative and anxiolytic agent dexmedetomidine and its use in the pediatric cardiac ICU. This agent, which was initially introduced for short term sedation, is increasingly used in our postoperative cardiac patients and we explore issues related to its use with particular attention to the issue of withdrawal. Dr. Michael Ushay, Director of Pediatric Critical Care at The Children’s Hospital at Montefiore joins us to provide clinical insight and perspective.
This week we devote the episode to congenital cardiac electrophysiology. We review 2 works - the first on outcomes of ablation for the treatment of atrial arrhythmias in Ebstein's anomaly and the second focuses on the ablation of posteroseptal accessory pathways in children, risks for coronary injury and strategies to avoid this potential serious complication. We are joined by Dr. Christopher McLeod of the Mayo Clinic to speak about his work on ablation of atrial arrhythmias in Ebstein's. His large experience and insights provide good perspective on this very challenging group of patients.
This week we review the most recent report of the SVR trial study group. The great economic cognitive and mathematical psychologist Amos Tversky once said "The world is not kind to collaboration." However, the SVR trial may just be the exception to prove Professor Tversky's rule. This month the group reports on how patients are doing 6 years after Stage I Palliation (Norwood) for HLHS -> RV-PA shunt vs. modified BT shunt and we delve into these important results. Dr. Rick Ohye, director of pediatric cardiovascular surgery at CS Mott Children’s Hospital and the senior author of this work joins us to discuss this paper (from Circulation) and also his insights into the findings in this trial so far as well as delving into the challenges he faced when starting such a massive "collaboration".
This week we review 2 important aspects of pediatric cardiovascular surgery - postoperative evaluation of pulmonary vein repair and management of the anomalous coronary artery for the prevention of sudden cardiac death. Dr. Carlos Mery of Texas Children's Hospital joins us to discuss the findings of a recent project he published on a large series of operations for these disorders.
This week's podcast explores the adult Fontan patient and the substantial challenges these patients face. We review 2 very recent articles on adult Fontan patients and explore the topic further with Dr. Ali Zaidi, Director of The Adult Congenital Heart Program at Montefiore Medical Center. Dr. Zaidi has a number of insights into these papers based upon his extensive clinical experience. This episode is dedicated to the memory of Professor Francis Fontan who passed last month. His impact on the lives of our congenital heart patients is inestimable.
On this podcast we explore two very recent papers on the topic of cardiac catheterization. The first is a large study reviewing the impact of NaHC03 + /- acetylcysteine on prevention of contrast nephropathy and the second is a comparison of endocarditis rates in surgical versus transcatheter pulmonary valve replacement. Dr. Gentian Lluri, the first author of the PVR paper joins us to discuss this work from UCLA and the "take away" points. As last week, we end with a wonderful piece from an operatic legend. Please leave a review or comment in iTunes! See you next week and I hope you enjoy....
This episode is in memory to Dr. Arthur Moss. We have today Dr. David Auerbach who was a key recent collaborator to review his 2 new recent works with Dr. Moss on the effects of antiseizure and antidepressant medications on LQTS patients. The discussion is very interesting and Dr. Auerbach shares his warm feelings for Dr. Moss with the audience. Finally, we end the podcast with a brief piece of opera.
Today we have 2 wonderful guests - Dr. Kenan Stern of Mt. Sinai Medical Center in NY, NY and Dr. Nadine Choueiter speaking on 2 different papers/topics. The papers reviewed are:
Utility of a standardized postcardiopulmonary bypass epicardial echocardiography protocol for stage I Norwood palliation and
Environmental epidemiology of Kawasaki disease: Linking disease etiology, pathogenesis and global distribution
Dr. Choueiter also references: Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association and the link for this important statement is:
http://circ.ahajournals.org/content/early/2017/03/29/CIR.0000000000000484
I hope you enjoy the podcast. Please leave comments and rate us on iTunes!
We review 2 articles today:
Prevalence and risk factors associated with non-attendance in neurodevelopment follow-up clinic among infants with CHD - Cardiology in the Young 2018
Psychiatric Disorders and Function in Adolescents with Tetralogy of Fallot - J Peds 2017
Both wonderful works that analyze under appreciated areas of care for our patients with CHD. Please review our podcast on iTunes - your listening and reviews are very much appreciated!